Provider Demographics
NPI:1285901728
Name:HORTON, SELENA MARIE (LMSW, LSW)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:MARIE
Last Name:HORTON
Suffix:
Gender:F
Credentials:LMSW, LSW
Other - Prefix:
Other - First Name:SELENA
Other - Middle Name:MARIE
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:24 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4715
Mailing Address - Country:US
Mailing Address - Phone:646-708-4275
Mailing Address - Fax:
Practice Address - Street 1:24 HIGH ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4715
Practice Address - Country:US
Practice Address - Phone:646-708-4275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4SL06813000104100000X
NY079041104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker