Healthcare Provider Details

I. General information

NPI: 1134201320
Provider Name (Legal Business Name): LORRAINE ANNETTE HORNUNG LCSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

484 EAST CARMEL DRIVE 376
CARMEL IN
46032
US

IV. Provider business mailing address

4715 VIEWRIDGE AVENUE SUITE 230
SAN DIEGO CA
92123-1680
US

V. Phone/Fax

Practice location:
  • Phone: 800-257-8715
  • Fax: 800-819-1655
Mailing address:
  • Phone: 800-257-8715
  • Fax: 800-819-1655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34001410A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: