Provider Demographics
NPI:1356827851
Name:CRISTOFARO, HOLLY H (LICSW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:H
Last Name:CRISTOFARO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-2948
Mailing Address - Country:US
Mailing Address - Phone:518-573-4521
Mailing Address - Fax:
Practice Address - Street 1:120 LONGWATER DR
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1653
Practice Address - Country:US
Practice Address - Phone:518-573-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA119039104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker