Provider Demographics
NPI:1760678536
Name:LIGHT, HOLLY GRACE (MBA)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:GRACE
Last Name:LIGHT
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BLANKEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134-2407
Mailing Address - Country:US
Mailing Address - Phone:415-330-5751
Mailing Address - Fax:
Practice Address - Street 1:100 BLANKEN AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-2407
Practice Address - Country:US
Practice Address - Phone:415-330-5751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical