Provider Demographics
NPI:1467516468
Name:HOLCOMBE, JON W (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:W
Last Name:HOLCOMBE
Suffix:
Gender:M
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:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01004-0132
Mailing Address - Country:US
Mailing Address - Phone:413-687-0480
Mailing Address - Fax:
Practice Address - Street 1:48 N PLEASANT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1738
Practice Address - Country:US
Practice Address - Phone:413-687-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1148131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1467516468Other474605872