Provider Demographics
NPI:1962879056
Name:HOLOBORODKO, OLYA (LMSW)
Entity type:Individual
Prefix:
First Name:OLYA
Middle Name:
Last Name:HOLOBORODKO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1923
Mailing Address - Country:US
Mailing Address - Phone:973-523-0089
Mailing Address - Fax:
Practice Address - Street 1:655 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1923
Practice Address - Country:US
Practice Address - Phone:973-523-0089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06017000104100000X
NY72 093334104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker