Provider Demographics
NPI:1356998785
Name:HOLL, ELLENA (LMSW)
Entity type:Individual
Prefix:
First Name:ELLENA
Middle Name:
Last Name:HOLL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1314
Mailing Address - Country:US
Mailing Address - Phone:607-745-0032
Mailing Address - Fax:
Practice Address - Street 1:297 RIVER STREET SERVICE RD
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2268
Practice Address - Country:US
Practice Address - Phone:607-441-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098188104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker