Provider Demographics
NPI:1730275066
Name:BORNHORST, MICHAEL SCOTT (MSW LICSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:BORNHORST
Suffix:
Gender:M
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5 BESSOM ST
Mailing Address - Street 2:#317
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945
Mailing Address - Country:US
Mailing Address - Phone:617-233-6953
Mailing Address - Fax:781-639-2014
Practice Address - Street 1:66 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945
Practice Address - Country:US
Practice Address - Phone:781-631-8273
Practice Address - Fax:781-631-7264
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW1132691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical