Provider Demographics
NPI:1346549441
Name:HORTON, JOANN LORAINE (LCSW-R)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:LORAINE
Last Name:HORTON
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6775
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14851-6775
Mailing Address - Country:US
Mailing Address - Phone:607-229-0725
Mailing Address - Fax:
Practice Address - Street 1:222 S ALBANY ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5471
Practice Address - Country:US
Practice Address - Phone:607-229-0725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0763551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical