Healthcare Provider Details

I. General information

NPI: 1346460151
Provider Name (Legal Business Name): KAREN HOLLER PHD NEUROPSYCHOLOGY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 BLACKSTONE BLVD
PROVIDENCE RI
02906-4800
US

IV. Provider business mailing address

PO BOX 603102
PROVIDENCE RI
02906-0102
US

V. Phone/Fax

Practice location:
  • Phone: 401-455-0221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS000844
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS000626
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS000844
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS000626
License Number StateRI

VIII. Authorized Official

Name: KAREN HOLLER
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 401-455-0221