Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 103951-1 | NY |
NPI | 1063984805 |
---|---|
Provider Name | Kylie R Horner |
First Address | Brooklyn, NY 11222-4524 |
Second Address | New York, NY 10019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2018 |
Last Update Date | 18/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103951-1 | STATE ED (01) | NY |