Provider Demographics
NPI:1548850902
Name:HORN, ROSALEEN JACOBS (LP, NCPSYA, MS ED)
Entity type:Individual
Prefix:
First Name:ROSALEEN
Middle Name:JACOBS
Last Name:HORN
Suffix:
Gender:F
Credentials:LP, NCPSYA, MS ED
Other - Prefix:
Other - First Name:ROSALEEN
Other - Middle Name:RUSTY
Other - Last Name:JORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LP, NCPSYA, MS ED
Mailing Address - Street 1:125 WEST 80TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-7101
Mailing Address - Country:US
Mailing Address - Phone:212-799-0695
Mailing Address - Fax:
Practice Address - Street 1:125 WEST 80TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-7101
Practice Address - Country:US
Practice Address - Phone:212-799-0695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000110-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst