Provider Demographics
NPI:1679327977
Name:HOLLOWAY, MARISSA MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:MARIE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MILL ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SODUS
Mailing Address - State:NY
Mailing Address - Zip Code:14551-1162
Mailing Address - Country:US
Mailing Address - Phone:315-573-1520
Mailing Address - Fax:
Practice Address - Street 1:31 MILL ST APT 1
Practice Address - Street 2:
Practice Address - City:SODUS
Practice Address - State:NY
Practice Address - Zip Code:14551-1162
Practice Address - Country:US
Practice Address - Phone:315-573-1520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112603104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker