Provider Demographics
NPI:1215276696
Name:HEREDIA, HOLLY MARY (MSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARY
Last Name:HEREDIA
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:MARY
Other - Last Name:DENNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1445 VETERANS MEMORIAL CIR STE B
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-3011
Mailing Address - Country:US
Mailing Address - Phone:530-822-7513
Mailing Address - Fax:
Practice Address - Street 1:1445 VETERANS MEMORIAL CIR STE B
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-3011
Practice Address - Country:US
Practice Address - Phone:530-822-7513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1010061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical