Provider Demographics
NPI:1871816470
Name:HOLT, AMY L (LSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:HOLT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:NEWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:2803 AKRON RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7535 GRANGER RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44125-4818
Practice Address - Country:US
Practice Address - Phone:216-447-9600
Practice Address - Fax:216-447-9603
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0016098104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker