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General NPI Number Information
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NPI Number | 1497896633
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Entity Type | Individual
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Provider Name | CHRISTOPHER D. HOLLEY LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 41 NORTH MAIN STREET FAMILY RESOURCE AND DEVELOPMENT CENTER LLC SUITE 303
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City | HARTFORD
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State | CT
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Zip | 06107
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Country | US
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Telephone | 860-838-4735
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Fax | 860-461-1514
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Provider Business Mailing Address
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Address Line | 182 MILTON ST
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1220
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Country | US
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Telephone | 860-233-2899
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 004376
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License Number State | CT
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