Healthcare Provider Details

I. General information

NPI: 1821217175
Provider Name (Legal Business Name): ELLEN HOLTZMAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 BROAD ST
NASHUA NH
03064-2011
US

IV. Provider business mailing address

40 IRVING ST
MELROSE MA
02176-4839
US

V. Phone/Fax

Practice location:
  • Phone: 603-889-8781
  • Fax:
Mailing address:
  • Phone: 781-665-8164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number579
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: