Provider Demographics
NPI:1508127747
Name:MCGAW-HOLIDAY, CHEVANESE DELARENE CHRISTINE (SW)
Entity Type:Individual
Prefix:
First Name:CHEVANESE
Middle Name:DELARENE CHRISTINE
Last Name:MCGAW-HOLIDAY
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 UNION ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1866
Mailing Address - Country:US
Mailing Address - Phone:978-688-4830
Mailing Address - Fax:
Practice Address - Street 1:15 UNION ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1866
Practice Address - Country:US
Practice Address - Phone:978-688-4830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker