Provider Demographics
NPI:1215500392
Name:HORNTHAL, MARTHA (LMHC)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:HORNTHAL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 GRAND ST APT J3E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4210
Mailing Address - Country:US
Mailing Address - Phone:646-265-0748
Mailing Address - Fax:
Practice Address - Street 1:550 GRAND ST APT J3E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4210
Practice Address - Country:US
Practice Address - Phone:646-265-0748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004322101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health