Provider Demographics
NPI:1932192531
Name:HOLMES, DEBRA BLAY (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:BLAY
Last Name:HOLMES
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 1:3821 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3019
Mailing Address - Country:US
Mailing Address - Phone:619-297-0023
Mailing Address - Fax:
Practice Address - Street 1:3821 FRONT ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3019
Practice Address - Country:US
Practice Address - Phone:619-297-0023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS202381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS20238OtherBLUE CROSS OF CALIFORNIA
CACSW202380Medicaid
CALCS202380OtherBLUE SHIELD OF CALIFORNIA
CALCS20238OtherBLUE CROSS OF CALIFORNIA
CALCS20238OtherBLUE CROSS OF CALIFORNIA