Provider Demographics
NPI:1174275788
Name:HOLZER, SHAWNA (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:HOLZER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 TWIN LAKES RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-1215
Mailing Address - Country:US
Mailing Address - Phone:646-596-3526
Mailing Address - Fax:
Practice Address - Street 1:243 TWIN LAKES RD
Practice Address - Street 2:
Practice Address - City:NORTH BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06471-1215
Practice Address - Country:US
Practice Address - Phone:646-596-3526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0118701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical