Provider Demographics
NPI:1679642656
Name:HARRIS, HOLLY A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:A
Last Name:HARRIS
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 1:3S101 ROCKWELL ST UNIT 524
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-2965
Mailing Address - Country:US
Mailing Address - Phone:630-660-7248
Mailing Address - Fax:
Practice Address - Street 1:24W788 75TH ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-1684
Practice Address - Country:US
Practice Address - Phone:630-660-7248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490054221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL477735OtherVALUE OPTIONS
IL2232888OtherBLUE CROSS BLUE SHIELD
IL9397361OtherPRIVATE HEALTHCARE SYSTEM
IL100091935OtherAPS HEALTHCARE