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General NPI Number Information
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NPI Number | 1568558831
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Entity Type | Organization
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Legal Business Name | HORIZON HOUSE
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 02/28/2012
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Provider Practice Location Address
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Address Line | 7 CLAYTON AVENUE
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City | CORTLAND
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State | NY
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Zip | 13045
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Country | US
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Telephone | 607-758-6100
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Fax | 607-758-6116
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Provider Business Mailing Address
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Address Line | 7 CLAYTON AVENUE
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City | CORTLAND
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State | NY
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Zip | 13045
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Country | US
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Telephone | 607-753-6751
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Fax | 607-756-4306
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Authorized Official
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Title or Position | DIRECTOR OF COMMUNITY SERVICES
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Name | MR. MARK D. THAYER
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Credential |
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Telephone | 607-758-6110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 043908-1
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License Number State | NY
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