MEDICARE: NICOLE HOLOBOFF MSED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YS0200X	School Counselor

General Provider Information

NPI Number	:	1194667089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE HOLOBOFF MSED

Provider Business Mailing Address
First Line	:	13 IRIS CIR
Second Line	:
City	:	BEACON
State	:	NY
Zip	:	12508-3931
Country	:	US
Telephone Number	:	914-610-9747
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 IRIS CIR
Second Line	:
City	:	BEACON
State	:	NY
Zip	:	12508-3931
Country	:	US
Telephone Number	:	914-610-9747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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