Provider Demographics
NPI:1477850576
Name:HORAK, DAWN M
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:HORAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:M
Other - Last Name:LAMIRANDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:55 CRYSTAL AVE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1702
Mailing Address - Country:US
Mailing Address - Phone:603-425-9206
Mailing Address - Fax:603-216-5952
Practice Address - Street 1:55 CRYSTAL AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1702
Practice Address - Country:US
Practice Address - Phone:603-425-9206
Practice Address - Fax:603-216-5952
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst