Provider Demographics
NPI:1477703791
Name:HOLCOMB, PORSCHE (LCSW)
Entity Type:Individual
Prefix:
First Name:PORSCHE
Middle Name:
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 BROADWAY # 1037
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1729
Mailing Address - Country:US
Mailing Address - Phone:917-773-8270
Mailing Address - Fax:855-924-2772
Practice Address - Street 1:333 AVENUE X 2ND FL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223
Practice Address - Country:US
Practice Address - Phone:917-773-8270
Practice Address - Fax:855-924-2772
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
MELC180981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical