Provider Demographics
NPI:1902120769
Name:HOLT, STACEY M
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:M
Last Name:HOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 OAK ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2217
Mailing Address - Country:US
Mailing Address - Phone:415-431-8252
Mailing Address - Fax:415-431-3195
Practice Address - Street 1:1140 OAK ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2217
Practice Address - Country:US
Practice Address - Phone:415-431-8252
Practice Address - Fax:415-431-3195
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator