Provider Demographics
NPI:1285946251
Name:HOLDEN, JENNIE (PHD)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 N MAIN ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-4170
Mailing Address - Country:US
Mailing Address - Phone:802-272-2545
Mailing Address - Fax:
Practice Address - Street 1:136 N MAIN ST
Practice Address - Street 2:UNIT 1
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4170
Practice Address - Country:US
Practice Address - Phone:802-272-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048.0098981103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285628552OtherAGENCY NPI
00355940OtherAGENCY MEDICAID
1285628552OtherAGENCY NPI