Provider Demographics
NPI:1215515770
Name:HOLMES, CORY MICHAEL (MSW, LCSWI)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:MICHAEL
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MSW, LCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 20TH ST STE 378
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-1014
Mailing Address - Country:US
Mailing Address - Phone:321-426-8030
Mailing Address - Fax:
Practice Address - Street 1:6200 20TH ST STE 378
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-1014
Practice Address - Country:US
Practice Address - Phone:321-426-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW14943104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker