Provider Demographics
NPI:1245346287
Name:HOROWITZ, NEIL DAVID (PHD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:DAVID
Last Name:HOROWITZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 EMERALD TER
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2312
Mailing Address - Country:US
Mailing Address - Phone:618-233-0500
Mailing Address - Fax:618-233-7935
Practice Address - Street 1:6 EMERALD TER
Practice Address - Street 2:SUITE 4
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2312
Practice Address - Country:US
Practice Address - Phone:618-233-0500
Practice Address - Fax:618-233-7935
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004616103TC0700X
MOR0457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200719Medicare UPIN