Provider Demographics
NPI:1659701282
Name:HOLNESS, PATRICE (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:HOLNESS
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 1:37 EVERGREEN PL
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2154
Mailing Address - Country:US
Mailing Address - Phone:973-266-7983
Mailing Address - Fax:
Practice Address - Street 1:37 EVERGREEN PL
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2154
Practice Address - Country:US
Practice Address - Phone:973-266-7983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05759900101YM0800X
NJ44SC05648200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health