Provider Demographics
NPI:1134773302
Name:INNER HORIZONS, LLC
Entity type:Organization
Organization Name:INNER HORIZONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ELOISE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:POTENZA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:518-576-9858
Mailing Address - Street 1:11 PEEL ST
Mailing Address - Street 2:
Mailing Address - City:SELKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:12158-9734
Mailing Address - Country:US
Mailing Address - Phone:518-576-8423
Mailing Address - Fax:518-314-0886
Practice Address - Street 1:1401 UNION ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-3023
Practice Address - Country:US
Practice Address - Phone:518-576-8423
Practice Address - Fax:518-314-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health