Provider Demographics
NPI:1053813519
Name:FLORA-HOLMQUIST, JADE (LMSW)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:FLORA-HOLMQUIST
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25899
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-5899
Mailing Address - Country:US
Mailing Address - Phone:630-272-6334
Mailing Address - Fax:
Practice Address - Street 1:162 SUMAC ST APT 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3890
Practice Address - Country:US
Practice Address - Phone:484-393-5993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW134988104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker