Provider Demographics
NPI:1639625098
Name:HOLMES, LIAMA (LCSW)
Entity Type:Individual
Prefix:
First Name:LIAMA
Middle Name:
Last Name:HOLMES
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 1:3580 MAIN ST
Mailing Address - Street 2:#6
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120-1121
Mailing Address - Country:US
Mailing Address - Phone:860-977-9790
Mailing Address - Fax:
Practice Address - Street 1:3580 MAIN ST
Practice Address - Street 2:#6
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-1121
Practice Address - Country:US
Practice Address - Phone:860-977-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03-3820621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical