Provider Demographics
NPI:1063495646
Name:HOLDEN, MARIA TIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:TIA
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4441
Mailing Address - Country:US
Mailing Address - Phone:415-215-2847
Mailing Address - Fax:415-771-7044
Practice Address - Street 1:1738 UNION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4441
Practice Address - Country:US
Practice Address - Phone:415-215-2847
Practice Address - Fax:415-771-7044
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18261103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL182610Medicare ID - Type UnspecifiedMEDICARE