Provider Demographics
NPI:1104841311
Name:HOLMES, CARL F (LCSW)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:F
Last Name:HOLMES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 KINGSLEY AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4553
Mailing Address - Country:US
Mailing Address - Phone:904-269-7200
Mailing Address - Fax:904-278-8891
Practice Address - Street 1:1409 KINGSLEY AVE STE 8
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4553
Practice Address - Country:US
Practice Address - Phone:904-269-7200
Practice Address - Fax:904-269-0070
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW14131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S30536Medicare UPIN
FLZ6084XMedicare ID - Type Unspecified