Provider Demographics
NPI:1588980718
Name:HOLDER, NICOLA A (PSYD)
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:A
Last Name:HOLDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 108TH ST
Mailing Address - Street 2:APT # 2N
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4501
Mailing Address - Country:US
Mailing Address - Phone:718-926-8090
Mailing Address - Fax:
Practice Address - Street 1:10470 QUEENS BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3638
Practice Address - Country:US
Practice Address - Phone:718-275-6010
Practice Address - Fax:718-275-6062
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist