MEDICARE: JESSICA MARIE HOLMES MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1790915346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARIE HOLMES MA

Provider Business Mailing Address
First Line	:	324 CLARK ST REAR 2ND
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01606-1214
Country	:	US
Telephone Number	:	508-791-4976
Fax Number	:	508-791-6723

Provider Business Practice Location Address
First Line	:	324 CLARK ST REAR 2ND
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01606-1214
Country	:	US
Telephone Number	:	508-791-4976
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2009
Last Update Date	:	10/04/2019

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