Provider Demographics
NPI:1033833710
Name:HOLLIS, KIMBERLEY MARIE (PHD)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:MARIE
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1232
Mailing Address - Country:US
Mailing Address - Phone:716-818-2462
Mailing Address - Fax:
Practice Address - Street 1:34 BENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1761
Practice Address - Country:US
Practice Address - Phone:716-986-9199
Practice Address - Fax:716-869-6402
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker