MEDICARE: DR. MICHELE MARYANN HORN-ALSBERGE 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	PS016577	PA
2	103TC0700X	Clinical Psychologist	35S100489200	NJ

General Provider Information

NPI Number	:	1902003031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELE MARYANN HORN-ALSBERGE PH.D.

Provider Business Mailing Address
First Line	:	814 MONROE ST
Second Line	:	SUITE 105
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-1744
Country	:	US
Telephone Number	:	570-420-9494
Fax Number	:	570-420-9494

Provider Business Practice Location Address
First Line	:	814 MONROE ST
Second Line	:	STE 105
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-1744
Country	:	US
Telephone Number	:	570-420-9494
Fax Number	:	570-420-9494

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

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	03/25/2014

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