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NPI Code Detail

MEDICARE: KATHY HOLDER MSW

MEDICARE: KATHY HOLDER MSW
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1689954927
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHY HOLDER MSW
Provider Business Mailing Address
First Line : 3524 83RD ST
Second Line :
City : JACKSON HEIGHTS
State : NY
Zip : 11372-5229
Country : US
Telephone Number : 718-639-0700
Fax Number :
Provider Business Practice Location Address
First Line : 3524 83RD ST
Second Line :
City : JACKSON HEIGHTS
State : NY
Zip : 11372-5229
Country : US
Telephone Number : 718-639-0700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2011
Last Update Date : 08/18/2011

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