Provider Demographics
NPI:1033566542
Name:HOLT, WARREN
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:
Last Name:HOLT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W 13TH ST
Mailing Address - Street 2:NPAP
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7940
Mailing Address - Country:US
Mailing Address - Phone:917-535-6603
Mailing Address - Fax:
Practice Address - Street 1:40 W 13TH ST
Practice Address - Street 2:NPAP
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7940
Practice Address - Country:US
Practice Address - Phone:917-535-6603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000954103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis