Healthcare Provider Details

I. General information

NPI: 1104214105
Provider Name (Legal Business Name): CHIMERE HOLMES M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 S 16TH ST
PHILADELPHIA PA
19102-4908
US

IV. Provider business mailing address

117 W GAY ST STE 314
WEST CHESTER PA
19380-2938
US

V. Phone/Fax

Practice location:
  • Phone: 215-642-8301
  • Fax:
Mailing address:
  • Phone: 215-642-8301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: