Provider Demographics
NPI:1083319727
Name:HOROWITZ, KELLY SHEA MCMEEN (PSY D)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:SHEA MCMEEN
Last Name:HOROWITZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:SHEA
Other - Last Name:MCMEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSY D
Mailing Address - Street 1:4848 BROADWAY APT 2C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-3147
Mailing Address - Country:US
Mailing Address - Phone:260-417-2482
Mailing Address - Fax:
Practice Address - Street 1:4848 BROADWAY APT 2C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-3147
Practice Address - Country:US
Practice Address - Phone:260-417-2482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025636103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical