MEDICARE: PORSCHE HOLCOMB LCSW, LCSW-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	087668	NY
2	1041C0700X	Clinical Social Worker	LC18098	ME
3	1041C0700X	Clinical Social Worker	25526	MD

General Provider Information

NPI Number	:	1477703791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PORSCHE HOLCOMB LCSW, LCSW-C

Provider Business Mailing Address
First Line	:	5110 BROADWAY # 1037
Second Line	:
City	:	WOODSIDE
State	:	NY
Zip	:	11377-1729
Country	:	US
Telephone Number	:	917-773-8270
Fax Number	:	855-924-2772

Provider Business Practice Location Address
First Line	:	5110 BROADWAY # 1037
Second Line	:
City	:	WOODSIDE
State	:	NY
Zip	:	11377-1729
Country	:	US
Telephone Number	:	917-773-8270
Fax Number	:	855-924-2772

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	04/13/2026

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