Provider Demographics
NPI:1073752432
Name:SANZ, JACQUELINE HORWITZ (PHD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:HORWITZ
Last Name:SANZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15245 SHADY GROVE RD STE 350
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6237
Mailing Address - Country:US
Mailing Address - Phone:202-476-5506
Mailing Address - Fax:
Practice Address - Street 1:15245 SHADY GROVE RD STE 350
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6237
Practice Address - Country:US
Practice Address - Phone:202-476-5506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04862103T00000X
DCPSY1000658103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist