MEDICARE: JEFFREY HOLMES PH.D.

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	103T00000X	Psychologist	020220	NY

General Provider Information

NPI Number	:	1649655754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY HOLMES PH.D.

Provider Business Mailing Address
First Line	:	410 W CHURCH ST
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-2603
Country	:	US
Telephone Number	:	607-737-1235
Fax Number	:	607-735-9617

Provider Business Practice Location Address
First Line	:	410 W CHURCH ST
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-2603
Country	:	US
Telephone Number	:	607-737-1235
Fax Number	:	607-735-9617

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

Provider Enumeration Date	:	07/30/2015
Last Update Date	:	07/30/2015

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