=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154604098
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLTZ AND WHITE MARRIAGE AND FAMILY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2011
-----------------------------------------------------
Last Update Date | 09/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 BUCK RD UNIT 500 SUITE 4
-----------------------------------------------------
City | HUNTINGDON VALLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19006-1544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-680-1128
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 BUCK RD UNIT 500 SUITE 4
-----------------------------------------------------
City | HUNTINGDON VALLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19006-1544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-680-1128
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MARRIAGE AND FAMILY THERAPIST
-----------------------------------------------------
Name | MS. ERICA SAMANTHA HOLTZ
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 215-680-1128
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MF000609
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------