Provider Demographics
NPI:1770953721
Name:HORN, MADELEINE AMELIA
Entity type:Individual
Prefix:MRS
First Name:MADELEINE
Middle Name:AMELIA
Last Name:HORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10890 INSPIRATION CIR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-5562
Mailing Address - Country:US
Mailing Address - Phone:925-785-1088
Mailing Address - Fax:
Practice Address - Street 1:1850 GATEWAY BLVD
Practice Address - Street 2:SUITE 900
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-3279
Practice Address - Country:US
Practice Address - Phone:925-785-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-03
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)