Provider Demographics
NPI:1700430790
Name:HOLMES, MEREDITH JANE (ASW)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:JANE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 GEARY BLVD APT 608
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2973
Mailing Address - Country:US
Mailing Address - Phone:917-238-0311
Mailing Address - Fax:
Practice Address - Street 1:1333 WILLOW PASS RD STE 101
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5225
Practice Address - Country:US
Practice Address - Phone:925-825-1793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-28
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X
CAASW67726104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No104100000XBehavioral Health & Social Service ProvidersSocial Worker