Provider Demographics
NPI:1801985759
Name:HORWITZ, MARK (LCSW CADC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:HORWITZ
Suffix:
Gender:M
Credentials:LCSW CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18345 1250 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:TISKILWA
Mailing Address - State:IL
Mailing Address - Zip Code:61368-9105
Mailing Address - Country:US
Mailing Address - Phone:815-646-4369
Mailing Address - Fax:815-872-5079
Practice Address - Street 1:1405 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-9771
Practice Address - Country:US
Practice Address - Phone:815-872-2100
Practice Address - Fax:815-872-5079
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL16864101YA0400X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211204Medicare PIN
ILK34249Medicare PIN