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General NPI Number Information
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NPI Number | 1134773302
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Entity Type | Organization
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Legal Business Name | INNER HORIZONS, LLC
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Dates
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Enumeration Date | 07/26/2019
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Last Update Date | 07/26/2019
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Provider Practice Location Address
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Address Line | 1401 UNION ST
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City | SCHENECTADY
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State | NY
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Zip | 12308-3023
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Country | US
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Telephone | 518-576-8423
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Fax | 518-314-0886
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Provider Business Mailing Address
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Address Line | 11 PEEL ST
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City | SELKIRK
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State | NY
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Zip | 12158-9734
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Country | US
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Telephone | 518-576-8423
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Fax | 518-314-0886
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Authorized Official
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Title or Position | OWNER/PRINCIPAL
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Name | DR. ELOISE MARIE POTENZA
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Credential | PSY.D.
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Telephone | 518-576-9858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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