Provider Demographics
NPI:1225817893
Name:HOLT, AUDREY L
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:L
Last Name:HOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CHADWICK CIR APT F
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-4789
Mailing Address - Country:US
Mailing Address - Phone:603-438-0305
Mailing Address - Fax:
Practice Address - Street 1:321 BILLERICA RD STE 28
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-4100
Practice Address - Country:US
Practice Address - Phone:888-896-5227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-23-68297103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst