Healthcare Provider Details

I. General information

NPI: 1265863666
Provider Name (Legal Business Name): MARIA T. HOLM LCSW, MSW, ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 E ARROW HWY BLDG E
UPLAND CA
91786-4984
US

IV. Provider business mailing address

1653 TRIANGLE DR
RIDGECREST CA
93555-2614
US

V. Phone/Fax

Practice location:
  • Phone: 760-499-3855
  • Fax: 760-499-3870
Mailing address:
  • Phone: 760-499-3617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60143
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW74491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: