Healthcare Provider Details

I. General information

NPI: 1578009908
Provider Name (Legal Business Name): BONNA LYNN HOROVITZ, LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 STAGE RD FLOOR 2
MONROE NY
10950-3551
US

IV. Provider business mailing address

8 HIGH MEADOW RD
GOSHEN NY
10924-5331
US

V. Phone/Fax

Practice location:
  • Phone: 845-605-2672
  • Fax:
Mailing address:
  • Phone: 845-294-5131
  • Fax: 845-294-0742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number0841384
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number0841384
License Number StateNY

VIII. Authorized Official

Name: BONNA LYNN HOROVITZ
Title or Position: MEMBER
Credential: LCSW
Phone: 845-605-2672