Provider Demographics
NPI:1649015777
Name:HORN, JEREMY DANIEL (LCSW)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:DANIEL
Last Name:HORN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 S 800 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3444
Mailing Address - Country:US
Mailing Address - Phone:301-613-3161
Mailing Address - Fax:
Practice Address - Street 1:306 WASHINGTON ST STE 1
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1766
Practice Address - Country:US
Practice Address - Phone:301-613-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-29
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2307041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical