Provider Demographics
NPI:1639786619
Name:FUSCALDO, HOLLY B (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:B
Last Name:FUSCALDO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:B
Other - Last Name:STUSEIRSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 KENYON AVE
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879
Mailing Address - Country:US
Mailing Address - Phone:701-788-1505
Mailing Address - Fax:401-782-3469
Practice Address - Street 1:100 KENYON AVE
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879
Practice Address - Country:US
Practice Address - Phone:701-788-1505
Practice Address - Fax:401-782-3469
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW023391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical