Provider Demographics
NPI:1497989115
Name:STAPLETON, HOLLY
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 N 9TH AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-5779
Mailing Address - Country:US
Mailing Address - Phone:814-330-6154
Mailing Address - Fax:
Practice Address - Street 1:404 N 9TH AVE
Practice Address - Street 2:APT 3
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-5779
Practice Address - Country:US
Practice Address - Phone:814-330-6154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126490104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker