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751 S Richmond Rd Ste D Ridgecrest CA 93555-8217 | |
(909) 932-1069 | |
Not Available |
Full Name | |
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Speciality | Social Worker |
Location | 751 S Richmond Rd Ste D, Ridgecrest, California |
Authorized Official Name and Position | Maria Holm (LICENSED CLINICAL SOCIAL WORKER) |
Authorized Official Contact | 7603715522 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 955 Ridgecrest CA 93556-0955 Ph: (760) 371-5522 | 751 S Richmond Rd Ste D Ridgecrest CA 93555-8217 Ph: (909) 932-1069 |
NPI Number | 1699448084 |
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Provider Enumeration Date | 07/30/2021 |
Last Update Date | 07/18/2023 |
Certification Date | 07/18/2023 |
Medicare PECOS PAC ID | 3779964564 |
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Medicare Enrollment ID | O20220726001379 |
Identifier | Type | State | Issuer |
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1699448084 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
Provider Name | Maria Teresa Holm |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1265863666 PECOS PAC ID: 2961787700 Enrollment ID: I20170317001940 |
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