Provider Demographics
NPI:1144428764
Name:VANHORN, GREGORY WILLIAM (LMSW)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:WILLIAM
Last Name:VANHORN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 HUNTER WOOD WAY
Mailing Address - Street 2:
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-7037
Mailing Address - Country:US
Mailing Address - Phone:814-237-0858
Mailing Address - Fax:
Practice Address - Street 1:134 HUNTER WOOD WAY
Practice Address - Street 2:
Practice Address - City:PORT MATILDA
Practice Address - State:PA
Practice Address - Zip Code:16870-7037
Practice Address - Country:US
Practice Address - Phone:814-237-0858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062423104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker