Provider Demographics
NPI:1568651586
Name:HOLLEY, ROBB WARREN (LCSW)
Entity type:Individual
Prefix:
First Name:ROBB
Middle Name:WARREN
Last Name:HOLLEY
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 S DAUPHIN AVE APT D15
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-2964
Mailing Address - Country:US
Mailing Address - Phone:813-846-7266
Mailing Address - Fax:
Practice Address - Street 1:2806 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-2653
Practice Address - Country:US
Practice Address - Phone:813-964-1964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW240151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58322OtherBLUE CROSS BLUE SHIELD
FL000326700Medicaid
FL000326700Medicaid
FLAO692YMedicare PIN