Provider Demographics
NPI:1093292047
Name:HENRY-NUSS, HOLLY ELIZABETH (LISW-S)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ELIZABETH
Last Name:HENRY-NUSS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ELIZABETH
Other - Last Name:NUSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW-S
Mailing Address - Street 1:55 W WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-1116
Mailing Address - Country:US
Mailing Address - Phone:330-724-7715
Mailing Address - Fax:
Practice Address - Street 1:55 W WATERLOO RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-1116
Practice Address - Country:US
Practice Address - Phone:330-724-7715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1451207-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical