Provider Demographics
NPI:1396894069
Name:HORN, MARY L (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:L
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 1:2610 NW 43RD STREET
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606
Mailing Address - Country:US
Mailing Address - Phone:352-378-0900
Mailing Address - Fax:352-378-7849
Practice Address - Street 1:2610 NW 43RD STREET
Practice Address - Street 2:SUITE 2C
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606
Practice Address - Country:US
Practice Address - Phone:352-378-0900
Practice Address - Fax:352-378-7849
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2292103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist