Provider Demographics
NPI:1003565771
Name:HOLLY RIOUX LICSW PLLC
Entity type:Organization
Organization Name:HOLLY RIOUX LICSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOUX
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-804-0948
Mailing Address - Street 1:66 HANOVER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-2230
Mailing Address - Country:US
Mailing Address - Phone:617-804-0948
Mailing Address - Fax:
Practice Address - Street 1:66 HANOVER ST STE 200
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-2230
Practice Address - Country:US
Practice Address - Phone:617-804-0948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health