Provider Demographics
NPI:1174286231
Name:HOLT, BENJAMIN G (LMSW)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:G
Last Name:HOLT
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:BENJAMIN
Other - Middle Name:
Other - Last Name:LOSURDO-HOLT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:12317 VILLAGE SQUARE TER APT 101
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1943
Mailing Address - Country:US
Mailing Address - Phone:716-753-6809
Mailing Address - Fax:
Practice Address - Street 1:319 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4855
Practice Address - Country:US
Practice Address - Phone:301-360-4349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD264321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical