Provider Demographics
NPI:1609071596
Name:LANDSBAUM, HOLLY (MSW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:LANDSBAUM
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:TANG CTR
Mailing Address - Street 2:2222 BANCROFT WAY, #4300
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-0001
Mailing Address - Country:US
Mailing Address - Phone:510-642-9494
Mailing Address - Fax:510-642-2368
Practice Address - Street 1:TANG CTR
Practice Address - Street 2:2222 BANCROFT WAY, #4300
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-0001
Practice Address - Country:US
Practice Address - Phone:510-642-9494
Practice Address - Fax:510-642-2368
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 187781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical