MEDICARE: CHRISTINE HOLMES

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	106S00000X	Behavior Technician		NY

General Provider Information

NPI Number	:	1538610308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE HOLMES

Provider Business Mailing Address
First Line	:	16 FREDERICK AVE
Second Line	:
City	:	LAKE GROVE
State	:	NY
Zip	:	11755-3212
Country	:	US
Telephone Number	:	631-901-7331
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 FREDERICK AVE
Second Line	:
City	:	LAKE GROVE
State	:	NY
Zip	:	11755-3212
Country	:	US
Telephone Number	:	631-901-7331
Fax Number	:

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

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	10/17/2016

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Directions to “ CHRISTINE HOLMES ” Practice Location

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