MEDICARE: GAIL E HOLLER-KENNEDY LMHC

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	101YM0800X	Mental Health Counselor	000501	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000506354005	OTHER	NY	COMMUNITY BLUE
2	00030241501	OTHER	NY	UNIVERA
3	091202000104	OTHER	NY	FIDELIS

General Provider Information

NPI Number	:	1790839447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL E HOLLER-KENNEDY LMHC

Provider Business Mailing Address
First Line	:	1868 NIAGARA FALLS BLVD
Second Line	:	SUITE 306
City	:	TONAWANDA
State	:	NY
Zip	:	14150-6494
Country	:	US
Telephone Number	:	716-200-9448
Fax Number	:

Provider Business Practice Location Address
First Line	:	7348 BEAR RIDGE RD
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-9520
Country	:	US
Telephone Number	:	716-200-9448
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	11/22/2013

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Directions to “ GAIL E HOLLER-KENNEDY LMHC” Practice Location

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