Ethlyn Holly

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

101 S Academy St
Greensboro, MD 21639-1643

Phone

(410) 404-4625

NPI assigned

Jul 10, 2015

Last updated

Nov 29, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, DC

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701216000000",
    "number": "1043694888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 29",
            "city": "GREENSBORO",
            "state": "MD",
            "postal_code": "216390029",
            "telephone_number": "410-404-4625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S ACADEMY ST",
            "city": "GREENSBORO",
            "state": "MD",
            "postal_code": "216391643",
            "telephone_number": "410-404-4625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLY",
        "first_name": "ETHLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-10",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MD",
            "license": "17713",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gingerly Supportive Home Care LLC
• Danielle Gravelle
• Greensboro Pharmacy, Inc.
• Health on Wheel Corporation
• Margaret Mary Herberger
• Jacqueline A McCarthy, RDH
• Joseph H. McCarthy, D.D.S.
• Hue Kim Nguyen, PHARMD
• Project Chesapeake, LLC
• Project Chesapeake, LLC

• Clinical Social Worker in Greensboro, MD
• Providers in Greensboro, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.