Provider Demographics
NPI:1205979903
Name:HORN, MARTHA JANE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:JANE
Last Name:HORN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3674
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20709-3674
Mailing Address - Country:US
Mailing Address - Phone:301-776-8554
Mailing Address - Fax:
Practice Address - Street 1:9811 MALLARD DR
Practice Address - Street 2:SUITE 211
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3143
Practice Address - Country:US
Practice Address - Phone:301-776-8554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0947101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional