Provider Demographics
NPI:1326623257
Name:HORTA, GIOVANIA
Entity Type:Individual
Prefix:
First Name:GIOVANIA
Middle Name:
Last Name:HORTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 DENTON ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-6643
Mailing Address - Country:US
Mailing Address - Phone:774-386-1322
Mailing Address - Fax:
Practice Address - Street 1:85 DENTON ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-6643
Practice Address - Country:US
Practice Address - Phone:774-386-1322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician