Provider Demographics
NPI:1053608463
Name:HOLLINGSWORTH, MARTHA WELLS (MSW, LSW, ACSW)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:WELLS
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:MSW, LSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5043 MERION CT
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2629
Mailing Address - Country:US
Mailing Address - Phone:609-625-3690
Mailing Address - Fax:609-625-5728
Practice Address - Street 1:44 COOPER ST
Practice Address - Street 2:SUITE 6
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096
Practice Address - Country:US
Practice Address - Phone:856-579-7303
Practice Address - Fax:856-579-7298
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL01498800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker