MEDICARE: DR MARY C HORN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY755	HI

General Provider Information

NPI Number	:	1073606760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR MARY C HORN LLC

Provider Business Mailing Address
First Line	:	45-955 KAMEHAMEHA HWY
Second Line	:	#306
City	:	KANEOHE
State	:	HI
Zip	:	96744-3222
Country	:	US
Telephone Number	:	808-247-2961
Fax Number	:	808-247-2962

Provider Business Practice Location Address
First Line	:	45-955 KAMEHAMEHA HWY
Second Line	:	#306
City	:	KANEOHE
State	:	HI
Zip	:	96744-3222
Country	:	US
Telephone Number	:	808-247-2961
Fax Number	:	808-247-2962

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARY C HORN
Credential	:	PSY.D.
Telephone Number	:	808-247-2961

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	02/12/2009

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Directions to “DR MARY C HORN LLC ” Practice Location

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