Provider Demographics
NPI:1114374337
Name:HORNBACK, VICTORIA ELIZABETH (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ELIZABETH
Last Name:HORNBACK
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E KINGS HWY
Mailing Address - Street 2:UNIT 221
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052-3434
Mailing Address - Country:US
Mailing Address - Phone:856-938-8932
Mailing Address - Fax:
Practice Address - Street 1:1256 MARLKRESS RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2626
Practice Address - Country:US
Practice Address - Phone:856-938-8932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-15-21111103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst