Provider Demographics
NPI:1396332862
Name:HOLCOMBE, CAELAN (MHC-LP)
Entity type:Individual
Prefix:
First Name:CAELAN
Middle Name:
Last Name:HOLCOMBE
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-7222
Mailing Address - Country:US
Mailing Address - Phone:585-489-8960
Mailing Address - Fax:844-792-1833
Practice Address - Street 1:300 HYLAN DR STE 6
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4216
Practice Address - Country:US
Practice Address - Phone:585-201-8418
Practice Address - Fax:844-792-8133
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP107024101YM0800X
NY013063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY013063OtherDIVISION OF PROFESSIONAL LICENSING SERVICES
NYP107024OtherDIVISION OF PROFESSIONAL LICENSING SERVICES