Provider Demographics
NPI:1821657727
Name:PARKER, HOLLY ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ELIZABETH
Last Name:PARKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ELIZABETH
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:12 MALLARD CV
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-1048
Mailing Address - Country:US
Mailing Address - Phone:518-894-8307
Mailing Address - Fax:
Practice Address - Street 1:12 MALLARD CV
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-1048
Practice Address - Country:US
Practice Address - Phone:518-894-8307
Practice Address - Fax:518-889-2024
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084881104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker