Provider Demographics
NPI:1740502582
Name:DARGUSH, HOLLY (LCSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:DARGUSH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SARATOGA AVE
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1846
Mailing Address - Country:US
Mailing Address - Phone:518-842-4260
Mailing Address - Fax:
Practice Address - Street 1:8 NORTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-3224
Practice Address - Country:US
Practice Address - Phone:518-843-7520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR022449-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical