Provider Demographics
NPI:1003447251
Name:HOLLINGSWORTH, SYDNEY MARIE
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:MARIE
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1374 CHAPEL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-1521
Mailing Address - Country:US
Mailing Address - Phone:510-731-4193
Mailing Address - Fax:
Practice Address - Street 1:7200 BANCROFT AVE STE 267
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2403
Practice Address - Country:US
Practice Address - Phone:510-948-0075
Practice Address - Fax:510-844-3385
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA144532101YM0800X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician