Provider Demographics
NPI:1770681850
Name:HORN, MARY C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:C
Last Name:HORN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-955 KAMEHAMEHA HWY STE 306
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3292
Mailing Address - Country:US
Mailing Address - Phone:808-247-2961
Mailing Address - Fax:808-247-2962
Practice Address - Street 1:45-955 KAMEHAMEHA HWY STE 306
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3292
Practice Address - Country:US
Practice Address - Phone:808-247-2961
Practice Address - Fax:808-247-2962
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY755103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55569101Medicaid
HI55569101Medicaid