Provider Demographics
NPI:1417006818
Name:WITTLIN-HORVATH, DENISE SYNDEE (LCSW-R, RN, NPP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:SYNDEE
Last Name:WITTLIN-HORVATH
Suffix:
Gender:F
Credentials:LCSW-R, RN, NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S ALBANY ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5446
Mailing Address - Country:US
Mailing Address - Phone:607-256-1167
Mailing Address - Fax:
Practice Address - Street 1:108 S ALBANY ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5446
Practice Address - Country:US
Practice Address - Phone:607-256-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0698551041C0700X
NY568571163W00000X
NYF40117-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY069855OtherLCSW
NY40117-1OtherNURSE PRACTITIONER PSYCH
NY568571OtherLIC. PROF. NURSE
NY40117-1OtherNURSE PRACTITIONER PSYCH