Healthcare Provider Details

I. General information

NPI: 1437060480
Provider Name (Legal Business Name): HOLLY ANN MASK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. HOLLY SKELLY

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 CUSHING RD
WARREN ME
04864-4600
US

IV. Provider business mailing address

4400 BEACON PLACE PKWY APT 605
TUSCALOOSA AL
35405-3225
US

V. Phone/Fax

Practice location:
  • Phone: 207-273-5300
  • Fax:
Mailing address:
  • Phone: 207-273-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC26491
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: