Provider Demographics
NPI:1538318829
Name:HUTYERA, HOLLY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:
Last Name:HUTYERA
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 1:1211 MIDDLE BELLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44904-1914
Mailing Address - Country:US
Mailing Address - Phone:315-552-4309
Mailing Address - Fax:
Practice Address - Street 1:1211 MIDDLE BELLVILLE RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44904-1914
Practice Address - Country:US
Practice Address - Phone:315-552-4309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI2008241041C0700X, 1041C0700X
NYR0511161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0249768Medicaid