Provider Demographics
NPI:1154099349
Name:HOLDERMAN, LENA R (LSW)
Entity Type:Individual
Prefix:MS
First Name:LENA
Middle Name:R
Last Name:HOLDERMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S ALLEN ST STE 326
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4851
Mailing Address - Country:US
Mailing Address - Phone:814-308-0704
Mailing Address - Fax:814-308-0705
Practice Address - Street 1:315 S ALLEN ST STE 326
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4851
Practice Address - Country:US
Practice Address - Phone:814-308-0704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW137984104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker