Provider Demographics
NPI:1497885222
Name:O'FLAHERTY, HOLLY CAMPBELL (MSSA, LISW)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:CAMPBELL
Last Name:O'FLAHERTY
Suffix:
Gender:F
Credentials:MSSA, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 ROCKPORT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5715
Mailing Address - Country:US
Mailing Address - Phone:216-941-9453
Mailing Address - Fax:
Practice Address - Street 1:15200 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4019
Practice Address - Country:US
Practice Address - Phone:216-509-3465
Practice Address - Fax:216-529-1630
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00054691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical