Provider Demographics
NPI:1851503106
Name:HOLM, SHERRY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:
Last Name:HOLM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SHERRY
Other - Middle Name:HOLM
Other - Last Name:THORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2425 PORTER ST
Mailing Address - Street 2:SUITE 5 E
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2444
Mailing Address - Country:US
Mailing Address - Phone:831-475-6478
Mailing Address - Fax:831-475-6478
Practice Address - Street 1:2425 PORTER ST
Practice Address - Street 2:SUITE 5 E
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2444
Practice Address - Country:US
Practice Address - Phone:831-475-6478
Practice Address - Fax:831-475-6478
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALS123081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25197ZMedicare ID - Type Unspecified