Provider Demographics
NPI:1629366877
Name:HORVAT, ELIZABETH JOAN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JOAN
Last Name:HORVAT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:JOAN
Other - Last Name:KITTLESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4505 WHITE BEAR PKWY STE 1500
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3697
Mailing Address - Country:US
Mailing Address - Phone:651-439-8150
Mailing Address - Fax:651-493-9335
Practice Address - Street 1:2230 COMO AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1720
Practice Address - Country:US
Practice Address - Phone:888-364-5977
Practice Address - Fax:844-385-4630
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0083861041C0700X
MN183581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical