Provider Demographics
NPI:1245737816
Name:HOLMES, DONNA (LMSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 RALPH AVE APT 4E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3852
Mailing Address - Country:US
Mailing Address - Phone:347-731-3866
Mailing Address - Fax:718-780-3171
Practice Address - Street 1:672 RALPH AVE APT 4E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3852
Practice Address - Country:US
Practice Address - Phone:347-731-3866
Practice Address - Fax:718-780-3171
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102074104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker