Provider Demographics
NPI:1528491511
Name:HORNBLASS, RICKY (PHD)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:
Last Name:HORNBLASS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 ENGLE ST
Mailing Address - Street 2:BUILDING #2, 2ND FLOOR
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2535
Mailing Address - Country:US
Mailing Address - Phone:201-632-3344
Mailing Address - Fax:
Practice Address - Street 1:163 ENGLE ST
Practice Address - Street 2:BUILDING #2, 2ND FLOOR
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2535
Practice Address - Country:US
Practice Address - Phone:201-632-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5016103TB0200X, 103TC0700X, 103TC2200X
NY018427-1103TB0200X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent