Provider Demographics
NPI:1386763746
Name:HOLMES, CHRISTINE ANN (LICSW)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ANN
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 OLD LOUISQUISSET PIKE STE 204
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4503
Mailing Address - Country:US
Mailing Address - Phone:401-487-3270
Mailing Address - Fax:
Practice Address - Street 1:825 CHALKSTONE AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4728
Practice Address - Country:US
Practice Address - Phone:401-456-4807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW006951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICA 03662Medicaid
RI409424OtherBLUE CHIP
RI62-42562OtherUNITED HEALTH CARE
RI30236-6OtherBLUE CROSS BLUE SHIELD
RI1021010OtherBEACON
RI05-0385696OtherCIGNA