Provider Demographics
NPI:1144380924
Name:HUMPHREYS, HOLLY (LICSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:
Last Name:HUMPHREYS
Suffix:
Gender:F
Credentials:LICSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-0003
Mailing Address - Country:US
Mailing Address - Phone:781-942-1372
Mailing Address - Fax:781-942-1372
Practice Address - Street 1:5 LONGFELLOW PL
Practice Address - Street 2:SUITE # 209
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2839
Practice Address - Country:US
Practice Address - Phone:781-942-1372
Practice Address - Fax:781-942-1372
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1025431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA005288OtherHARVARD PILGRIM
MAP01200OtherBLUE CROSS BLUE SHIELD
MAP01200OtherBLUE CROSS BLUE SHIELD