Provider Demographics
NPI:1710036637
Name:HORNFELD, GARY BRIAN (MSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:BRIAN
Last Name:HORNFELD
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6655 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9747
Mailing Address - Country:US
Mailing Address - Phone:989-753-8031
Mailing Address - Fax:
Practice Address - Street 1:6655 DAVIS RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9747
Practice Address - Country:US
Practice Address - Phone:989-753-8031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010135401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical