Provider Demographics
NPI:1467045237
Name:HOLLOMON, JEROME (LSW)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:HOLLOMON
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 1:1705 S DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-1634
Mailing Address - Country:US
Mailing Address - Phone:267-585-5628
Mailing Address - Fax:
Practice Address - Street 1:1705 S DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-1634
Practice Address - Country:US
Practice Address - Phone:215-668-6879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136160104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker