Provider Demographics
NPI:1619410792
Name:HORAK, KRISTIN H (LCSW, LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:H
Last Name:HORAK
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 31403 BOX 13
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09630-1403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USAHC-VICENZA
Practice Address - Street 2:LRMC
Practice Address - City:VICENZA
Practice Address - State:VENETO
Practice Address - Zip Code:36100
Practice Address - Country:IT
Practice Address - Phone:044-461-9610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01175251041C0700X
HI42641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical