Provider Demographics
NPI:1154414803
Name:HOLFELNER, KEVIN D (MS , LADC)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:D
Last Name:HOLFELNER
Suffix:
Gender:M
Credentials:MS , LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 93RD ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3748
Mailing Address - Country:US
Mailing Address - Phone:603-283-1561
Mailing Address - Fax:
Practice Address - Street 1:64 MAIN ST.
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431
Practice Address - Country:US
Practice Address - Phone:603-283-1561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH253251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81263595Medicaid