MEDICARE: SYDNEY VAN HORN LCSW

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	1041C0700X	Clinical Social Worker	LCSW-22085	AZ

General Provider Information

NPI Number	:	1174364145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY VAN HORN LCSW

Provider Business Mailing Address
First Line	:	2832 E WAYLAND DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-3764
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4115 E VALLEY AUTO DR STE 208
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4612
Country	:	US
Telephone Number	:	602-428-8078
Fax Number	:

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

Provider Enumeration Date	:	06/04/2024
Last Update Date	:	12/11/2024

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