MEDICARE: DR. ALISA HORWITZ PH.D.

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	103TC0700X	Clinical Psychologist	PY 60461280	WA

General Provider Information

NPI Number	:	1144676842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALISA HORWITZ PH.D.

Provider Business Mailing Address
First Line	:	2855 31ST AVE W
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-2722
Country	:	US
Telephone Number	:	215-380-8460
Fax Number	:

Provider Business Practice Location Address
First Line	:	2855 31ST AVE W
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-2722
Country	:	US
Telephone Number	:	215-380-8460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2016
Last Update Date	:	05/11/2016

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