Healthcare Provider Details

I. General information

NPI: 1619410792
Provider Name (Legal Business Name): KRISTIN H HORAK LCSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAHC-VICENZA LRMC
VICENZA VENETO
36100
IT

IV. Provider business mailing address

UNIT 31403 BOX 13
APO AE
09630-1403
US

V. Phone/Fax

Practice location:
  • Phone: 44-461-9610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0117525
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4264
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: