MEDICARE: ANDREW HOLST DO, LCSW

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
2	2084P0800X	Psychiatry Physician	202504078	NC

General Provider Information

NPI Number	:	1609114180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW HOLST DO, LCSW

Provider Business Mailing Address
First Line	:	183 S ORANGE AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-2757
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	183 S ORANGE AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-2757
Country	:	US
Telephone Number	:	336-430-7898
Fax Number	:

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

Provider Enumeration Date	:	01/17/2013
Last Update Date	:	06/01/2026

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