Provider Demographics
NPI:1124522891
Name:HOLLINGSWORTH, KIRBY PATRICK (LCSW)
Entity type:Individual
Prefix:MR
First Name:KIRBY
Middle Name:PATRICK
Last Name:HOLLINGSWORTH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 RAVINE AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4829
Mailing Address - Country:US
Mailing Address - Phone:267-664-1380
Mailing Address - Fax:
Practice Address - Street 1:51 RAVINE AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-4829
Practice Address - Country:US
Practice Address - Phone:267-664-1380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057750001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical