Provider Demographics
NPI:1477722817
Name:PERTMER, HOLLY HOELLER (LCSW-C)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:HOELLER
Last Name:PERTMER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14224 CANTRELL RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-4422
Mailing Address - Country:US
Mailing Address - Phone:301-384-3516
Mailing Address - Fax:
Practice Address - Street 1:9200 BASIL CT
Practice Address - Street 2:SUITE 200
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5309
Practice Address - Country:US
Practice Address - Phone:301-883-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD054121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05412OtherLCSW-C