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General NPI Number Information
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NPI Number | 1871781401
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Entity Type | Organization
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Legal Business Name | HOLTZ PSYCHOLOGICAL SERVICES, PC
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 20 BROADHOLLOW RD SUITE 2004
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City | MELVILLE
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State | NY
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Zip | 11747-2501
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Country | US
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Telephone | 631-427-6669
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Fax | 631-427-6669
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Provider Business Mailing Address
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Address Line | PO BOX 742
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City | MELVILLE
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State | NY
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Zip | 11747-0742
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Country | US
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Telephone | 631-427-6669
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Fax | 631-427-6669
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRED L. HOLTZ
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Credential | PH.D.
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Telephone | 631-427-6669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 010194-1
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License Number State | NY
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