=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831935071
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOLLOWAY TESTERMAN MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2024
-----------------------------------------------------
Last Update Date | 03/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 CORN HILL RD
-----------------------------------------------------
City | BOSCAWEN
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03303-2311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-545-7814
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 665 LAKE AVE
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03103-3539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-787-3140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------