Healthcare Provider Details

I. General information

NPI: 1780488650
Provider Name (Legal Business Name): KYLIE HORNER, LCSW, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 MAIN ST
BEACON NY
12508-2790
US

IV. Provider business mailing address

34 MELIO BETTINA PL
BEACON NY
12508-1940
US

V. Phone/Fax

Practice location:
  • Phone: 856-381-8485
  • Fax:
Mailing address:
  • Phone: 856-381-8485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KYLIE HORNER
Title or Position: OWNER
Credential:
Phone: 856-381-8485