Provider Demographics
NPI:1205407277
Name:HOLDEN, MITCH
Entity Type:Individual
Prefix:
First Name:MITCH
Middle Name:
Last Name:HOLDEN
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 1:221 PAWTUCKET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2958
Mailing Address - Country:US
Mailing Address - Phone:978-995-9527
Mailing Address - Fax:
Practice Address - Street 1:221 PAWTUCKET BLVD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2958
Practice Address - Country:US
Practice Address - Phone:978-995-9527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator