=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891913968
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN HORTON LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2627 MISSION ST
-----------------------------------------------------
City | SAN MARINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91108-1639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-429-6507
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2627 MISSION ST
-----------------------------------------------------
City | SAN MARINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91108-1639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-441-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCS 23669
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------