Provider Demographics
NPI:1558862854
Name:HOLLAND-GUY, FREDRICKA (LSW)
Entity Type:Individual
Prefix:
First Name:FREDRICKA
Middle Name:
Last Name:HOLLAND-GUY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MS
Other - First Name:FREDRICKA
Other - Middle Name:
Other - Last Name:HOLLAND-GUY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:401 CAPTAINS WAY
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-5209
Mailing Address - Country:US
Mailing Address - Phone:215-627-4834
Mailing Address - Fax:
Practice Address - Street 1:401 CAPTAINS WAY
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-5209
Practice Address - Country:US
Practice Address - Phone:215-627-4834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW003845104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker