Provider Demographics
NPI:1225552623
Name:HOLLIDAY, SUSIE JANE (RCSWI, MSW)
Entity Type:Individual
Prefix:MS
First Name:SUSIE
Middle Name:JANE
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:RCSWI, MSW
Other - Prefix:
Other - First Name:SUSIE
Other - Middle Name:JANE
Other - Last Name:LAFFERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18651 AYRSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-9683
Mailing Address - Country:US
Mailing Address - Phone:941-258-6567
Mailing Address - Fax:
Practice Address - Street 1:18651 AYRSHIRE CIR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-9683
Practice Address - Country:US
Practice Address - Phone:941-258-6567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW109731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical