Mark Edward Holderbach, M.S.W., L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L3497 Issued in OR

Practice address

4101 NE Division St
Gresham, OR 97030-4617

Phone

(503) 666-6575

Fax

(503) 666-4047

NPI assigned

Mar 22, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1649397183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14978 SW EMERALD CT",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970078560",
            "telephone_number": "503-666-6575",
            "fax_number": "503-666-4047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 NE DIVISION ST",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970304617",
            "telephone_number": "503-666-6575",
            "fax_number": "503-666-4047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLDERBACH",
        "first_name": "MARK",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "M.S.W., L.C.S.W.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-22",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L3497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1041C0700X CLINICAL",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Franco Hoffman, CNM/NP
• Ginna Alene Hoffman, MA, MFT, LPC
• Shyanne Jade Hoffman
• Katherine Marie Hogan, M.D.
• David Eric Holden, LMT
• Samuel Michael Holland, PCA
• Christopher L Holliday, CRM CADC-R
• Hollie Hefferman LMT LLC
• Afton Megan Hollister, QMHA -R
• Blake Holloway

• Clinical Social Worker in Gresham, OR
• Providers in Gresham, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.

Verify at the official NPI Registry.