Provider Demographics
NPI:1740777044
Name:GERETY, HOLLY (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:
Last Name:GERETY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 LEARNING LN
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-3321
Mailing Address - Country:US
Mailing Address - Phone:781-293-4023
Mailing Address - Fax:
Practice Address - Street 1:80 LEARNING LN
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-3321
Practice Address - Country:US
Practice Address - Phone:781-293-4023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1104521041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool