Provider Demographics
NPI:1255008397
Name:ROXANNE HORTA LCSW, INC.
Entity Type:Organization
Organization Name:ROXANNE HORTA LCSW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:HORTA
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:424-435-8790
Mailing Address - Street 1:2110 ARTESIA BLVD STE B-473
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3073
Mailing Address - Country:US
Mailing Address - Phone:424-435-8790
Mailing Address - Fax:
Practice Address - Street 1:2512 ARTESIA BLVD STE 305C
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3269
Practice Address - Country:US
Practice Address - Phone:424-435-8790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty