Provider Demographics
NPI:1124380605
Name:HOLMES, BEVERLY (MS SPECIAL EDUCATION)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MS SPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14754 VILLAGE RD
Mailing Address - Street 2:APT 88GA
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-6343
Mailing Address - Country:US
Mailing Address - Phone:917-605-5615
Mailing Address - Fax:
Practice Address - Street 1:14754 VILLAGE RD
Practice Address - Street 2:APT 88GA
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-6343
Practice Address - Country:US
Practice Address - Phone:917-605-5615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist