Provider Demographics
NPI:1295171049
Name:JAMISON, HOLLY NICHOLE (LISW)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:NICHOLE
Last Name:JAMISON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:NICHOLE
Other - Last Name:CONANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25700 SCIENCE PARK DR
Mailing Address - Street 2:#200
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7319
Mailing Address - Country:US
Mailing Address - Phone:216-831-1040
Mailing Address - Fax:216-831-2667
Practice Address - Street 1:24100 CHAGRIN BLVD
Practice Address - Street 2:#400
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5535
Practice Address - Country:US
Practice Address - Phone:216-831-1040
Practice Address - Fax:216-831-2667
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 13028471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
12700729OtherCAQH