Provider Demographics
NPI:1467828673
Name:GRGAS, HOLLY (LCSW, PMH-C)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:GRGAS
Suffix:
Gender:F
Credentials:LCSW, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1534
Mailing Address - Country:US
Mailing Address - Phone:845-553-3161
Mailing Address - Fax:
Practice Address - Street 1:149 NEWTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1534
Practice Address - Country:US
Practice Address - Phone:845-553-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
COCSW.099289061041C0700X
MELC208751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program