Provider Demographics
NPI:1801989769
Name:HOLLAND, LAUREL R (LICSW)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:R
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:RYAN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:227 GREAT ROAD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730
Mailing Address - Country:US
Mailing Address - Phone:781-354-0594
Mailing Address - Fax:
Practice Address - Street 1:227 GREAT ROAD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730
Practice Address - Country:US
Practice Address - Phone:781-354-0594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1069401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO 4385OtherBLUE CROSS OF MA