Provider Demographics
NPI:1093076010
Name:HOLMBERG, RANDY (LMHC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:HOLMBERG
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 UNION ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1112
Mailing Address - Country:US
Mailing Address - Phone:508-317-2323
Mailing Address - Fax:508-519-5619
Practice Address - Street 1:25 UNION ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1112
Practice Address - Country:US
Practice Address - Phone:508-317-2323
Practice Address - Fax:508-519-5619
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health