Provider Demographics
NPI:1790969608
Name:HOLMES, JANE S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:S
Last Name:HOLMES
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:PO BOX 864
Mailing Address - Street 2:
Mailing Address - City:WAINSCOTT
Mailing Address - State:NY
Mailing Address - Zip Code:11975-0864
Mailing Address - Country:US
Mailing Address - Phone:631-324-0564
Mailing Address - Fax:
Practice Address - Street 1:530 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:AMAGANSETT
Practice Address - State:NY
Practice Address - Zip Code:11930-2110
Practice Address - Country:US
Practice Address - Phone:631-786-4086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0696181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical