Provider Demographics
NPI:1003112178
Name:HAMAN-MARCUM, HOLLY (MSSW, LCSW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HAMAN-MARCUM
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:HAMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSW, LCSW
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80807-0726
Mailing Address - Country:US
Mailing Address - Phone:720-231-0353
Mailing Address - Fax:
Practice Address - Street 1:1371 1/2 ROSE AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-1601
Practice Address - Country:US
Practice Address - Phone:720-231-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW-9921061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21685835Medicaid
CO62673734Medicaid
CO12515136OtherCAQH
CO21685835Medicaid