Provider Demographics
NPI:1578611695
Name:HORTON, ROBERTA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 E 67TH ST
Mailing Address - Street 2:#18D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5914
Mailing Address - Country:US
Mailing Address - Phone:212-744-1407
Mailing Address - Fax:212-744-1407
Practice Address - Street 1:167 E 67TH ST
Practice Address - Street 2:#18D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5914
Practice Address - Country:US
Practice Address - Phone:212-744-1407
Practice Address - Fax:212-744-1407
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR019415-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN54551Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER