Provider Demographics
NPI:1013146638
Name:HOLLAND, FAWN M (MSW)
Entity Type:Individual
Prefix:MS
First Name:FAWN
Middle Name:M
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:FAWN
Other - Middle Name:M
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:576 E AFTON RD
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13733-2203
Mailing Address - Country:US
Mailing Address - Phone:607-967-2713
Mailing Address - Fax:
Practice Address - Street 1:5 COURT ST
Practice Address - Street 2:SUITE 42, COUNTY OFFICE BUILDING
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1695
Practice Address - Country:US
Practice Address - Phone:607-337-1600
Practice Address - Fax:607-334-4519
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health