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General NPI Number Information
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NPI Number | 1760879688
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Entity Type | Individual
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Provider Name | SHAWN HOLLAND
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Gender | Male
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Dates
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Enumeration Date | 04/17/2015
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Last Update Date | 02/09/2020
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Provider Practice Location Address
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Address Line | 21 GREENE AVE # 204
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City | AMITYVILLE
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State | NY
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Zip | 11701-2943
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Country | US
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Telephone | 516-743-8571
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Fax |
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Provider Business Mailing Address
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Address Line | 350 MARINERS WAY
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City | COPIAGUE
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State | NY
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Zip | 11726-5113
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 008697
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License Number State | NY
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