Provider Demographics
NPI:1649436031
Name:HOLLANDER, JEFFREY PHILLIP (MSW, LMSW)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:PHILLIP
Last Name:HOLLANDER
Suffix:
Gender:M
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 3 MILE RD NW
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49534-1133
Mailing Address - Country:US
Mailing Address - Phone:616-453-6100
Mailing Address - Fax:616-453-6157
Practice Address - Street 1:4175 3 MILE RD NW
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:49534-1133
Practice Address - Country:US
Practice Address - Phone:616-453-6100
Practice Address - Fax:616-453-6157
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010161321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801016132OtherMICHIGAN LICENSE
MIMI6372Medicare PIN