Provider Demographics
NPI:1609248558
Name:SCHRODER, HOLLY (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:HOLLY
Middle Name:
Last Name:SCHRODER
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 1:267 DONALD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-3829
Mailing Address - Country:US
Mailing Address - Phone:631-804-9699
Mailing Address - Fax:
Practice Address - Street 1:900 MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1623
Practice Address - Country:US
Practice Address - Phone:631-804-9699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0938031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical