Provider Demographics
NPI:1316014236
Name:HOLLM, RONALD EGON (LSW)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:EGON
Last Name:HOLLM
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 VALLEYVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-8744
Mailing Address - Country:US
Mailing Address - Phone:570-523-7125
Mailing Address - Fax:
Practice Address - Street 1:76 VALLEYVIEW RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-8744
Practice Address - Country:US
Practice Address - Phone:570-523-7125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW-012311-L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker