=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841341773
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GINGER MARIE HOLMAN L.C.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1309 EVANS AVE 2ND FLOOR
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94124-1705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-519-2605
-----------------------------------------------------
Fax | 510-763-6666
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 759 S VAN NESS AVE
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94110-1908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-642-4554
-----------------------------------------------------
Fax | 415-695-6963
-----------------------------------------------------
=====================================================
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 | 17626
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------