Active NPI
Jerome Holland, G.S.W.
- Clinical Social Worker
- Lake Charles, LA
National Provider Identifier
1174662928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6756
- Practice address
- 4105 Kirkman St
Lake Charles, LA 70607-4603 - Phone
- (337) 475-8022
- Fax
- (337) 475-8054
- NPI assigned
- Feb 6, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6756 | LA | Primary |
Addresses
Primary practice location
4105 Kirkman St
Lake Charles, LA 70607-4603
Mailing address
1723 N Tallowood Dr
Lake Charles, LA 70605-6409
Phone (504) 638-1086
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6756 | LA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174662928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1723 N TALLOWOOD DR",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706056409",
"telephone_number": "504-638-1086"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4105 KIRKMAN ST",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706074603",
"telephone_number": "337-475-8022",
"fax_number": "337-475-8054"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLAND",
"first_name": "JEROME",
"name_prefix": "Mr.",
"credential": "G.S.W.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "LA",
"license": "6756",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Charles, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.