Provider Demographics
NPI:1295860609
Name:HORN, EILEEN ROMM (LCSW)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:ROMM
Last Name:HORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:R
Other - Last Name:ROMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSWR
Mailing Address - Street 1:1601 THIRD AVE
Mailing Address - Street 2:7GW
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:646-596-7251
Mailing Address - Fax:
Practice Address - Street 1:1601 THIRD AVE
Practice Address - Street 2:7GW
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-996-1319
Practice Address - Fax:212-289-8271
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSWR0171751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R47451Medicare UPIN
NYN27871Medicare ID - Type UnspecifiedINACTIVE