Provider Demographics
NPI:1679769756
Name:FRIEDMAN, HOLLY (LICSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:GLICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:34 BRIMSTONE LN
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-3204
Mailing Address - Country:US
Mailing Address - Phone:978-443-6629
Mailing Address - Fax:
Practice Address - Street 1:1415 BEACON ST
Practice Address - Street 2:SUITE 307
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4816
Practice Address - Country:US
Practice Address - Phone:978-443-6629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1060391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical