Provider Demographics
NPI:1124180740
Name:HOLLIDAY, MAUREEN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:RUFINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:150 S HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4817
Mailing Address - Country:US
Mailing Address - Phone:774-826-2340
Mailing Address - Fax:774-826-2568
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:774-826-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA453101YA0400X
MA2103051041C0700X
MA248524261QV0200X
MA1138601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA