Healthcare Provider Details

I. General information

NPI: 1073585220
Provider Name (Legal Business Name): DAVID ANDREW HOLT CERT. SOCIAL WORKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 CHURCH ST
FREDONIA NY
14063-1761
US

IV. Provider business mailing address

33 CHURCH ST
FREDONIA NY
14063-1761
US

V. Phone/Fax

Practice location:
  • Phone: 716-785-6335
  • Fax: 716-785-6138
Mailing address:
  • Phone: 716-785-6335
  • Fax: 716-785-6138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: