Provider Demographics
NPI:1356335608
Name:HORNYAK, RAYMOND (PHD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:HORNYAK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 MINNO DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-1731
Mailing Address - Country:US
Mailing Address - Phone:814-255-7111
Mailing Address - Fax:
Practice Address - Street 1:1818 MINNO DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-1731
Practice Address - Country:US
Practice Address - Phone:814-255-7111
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003123L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA160704Medicare ID - Type UnspecifiedPSYCHOLOGIST