Provider Demographics
NPI:1568831204
Name:BAKER, HOLLY (MSW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68-131 E PUKAUA PL
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-9769
Mailing Address - Country:US
Mailing Address - Phone:808-895-5519
Mailing Address - Fax:808-887-1015
Practice Address - Street 1:68-131 E PUKAUA PL
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-9769
Practice Address - Country:US
Practice Address - Phone:808-895-5519
Practice Address - Fax:808-887-1015
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker