Provider Demographics
NPI:1518585520
Name:HORNE, MARVIN B (LMSW)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:B
Last Name:HORNE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-2829
Mailing Address - Country:US
Mailing Address - Phone:518-588-9456
Mailing Address - Fax:
Practice Address - Street 1:454 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-2829
Practice Address - Country:US
Practice Address - Phone:518-588-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105824104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker