Provider Demographics
NPI:1235458043
Name:JODIE R. HOLZMAN LICSW, LLC
Entity Type:Organization
Organization Name:JODIE R. HOLZMAN LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:HOLZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-987-4433
Mailing Address - Street 1:790 CLEVELAND AVE S
Mailing Address - Street 2:SUITE # 207
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-3858
Mailing Address - Country:US
Mailing Address - Phone:612-987-4433
Mailing Address - Fax:651-690-0968
Practice Address - Street 1:790 CLEVELAND AVE S
Practice Address - Street 2:SUITE # 207
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-3858
Practice Address - Country:US
Practice Address - Phone:612-987-4433
Practice Address - Fax:651-690-0968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN150221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty