Provider Demographics
NPI:1689712085
Name:HOLT, TIA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:HOLT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 INGLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-4110
Mailing Address - Country:US
Mailing Address - Phone:978-314-4519
Mailing Address - Fax:
Practice Address - Street 1:22 INGLEWOOD ST
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-4110
Practice Address - Country:US
Practice Address - Phone:978-314-4519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW2141641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical