Provider Demographics
NPI:1659461473
Name:HORNE, SANDRA S (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:S
Last Name:HORNE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PHEASANT ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-2419
Mailing Address - Country:US
Mailing Address - Phone:617-965-0649
Mailing Address - Fax:617-965-0649
Practice Address - Street 1:93 UNION STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-2241
Practice Address - Country:US
Practice Address - Phone:617-965-0649
Practice Address - Fax:617-965-0649
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1016041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAHOPO1546Medicare ID - Type Unspecified