Provider Demographics
NPI:1073122867
Name:UNDLIN WEISMANTEL, HOLLY (LCSW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:UNDLIN WEISMANTEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2473 S HIGLEY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1103
Mailing Address - Country:US
Mailing Address - Phone:602-881-8555
Mailing Address - Fax:
Practice Address - Street 1:4085 E CLAXTON AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297
Practice Address - Country:US
Practice Address - Phone:602-881-8555
Practice Address - Fax:888-375-5244
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND56631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical