Provider Demographics
NPI:1669697579
Name:HOLLERON, ALISA JAFFE
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:JAFFE
Last Name:HOLLERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 GOLDEN FOOTHILL PKWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9649
Mailing Address - Country:US
Mailing Address - Phone:916-933-5011
Mailing Address - Fax:916-933-5051
Practice Address - Street 1:232 LEE ST APT F1
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1488
Practice Address - Country:US
Practice Address - Phone:530-417-2869
Practice Address - Fax:916-933-5051
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA244521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical