Provider Demographics
NPI:1578679361
Name:HORN, MIRIAM KAZANSKY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:KAZANSKY
Last Name:HORN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:KAZANSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:720 E MAIN ST STE 2T
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3058
Mailing Address - Country:US
Mailing Address - Phone:856-304-7393
Mailing Address - Fax:
Practice Address - Street 1:720 E MAIN ST STE 2T
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057
Practice Address - Country:US
Practice Address - Phone:856-304-7393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00420700103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical