Provider Demographics
NPI:1902107196
Name:SOARES, HOLLY M (MS)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:M
Last Name:SOARES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2778
Mailing Address - Country:US
Mailing Address - Phone:508-821-7777
Mailing Address - Fax:
Practice Address - Street 1:70 MAIN ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2778
Practice Address - Country:US
Practice Address - Phone:508-821-7777
Practice Address - Fax:508-822-2601
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10882103TC0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health