Provider Demographics
NPI:1013384080
Name:HOLT, ABIGAIL V
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:V
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:PO BOX 3957
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06525-0957
Mailing Address - Country:US
Mailing Address - Phone:203-903-9363
Mailing Address - Fax:203-513-3352
Practice Address - Street 1:360 AMITY RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2133
Practice Address - Country:US
Practice Address - Phone:203-903-9363
Practice Address - Fax:203-513-3352
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-14-16414103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst