Provider Demographics
NPI:1407995897
Name:HOLLAND, MAUREEN ANTOINETTE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:ANTOINETTE
Last Name:HOLLAND
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 1:19231 VICTORY BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6321
Mailing Address - Country:US
Mailing Address - Phone:818-708-4500
Mailing Address - Fax:818-654-1956
Practice Address - Street 1:19231 VICTORY BLVD STE 110
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6321
Practice Address - Country:US
Practice Address - Phone:818-708-4500
Practice Address - Fax:818-654-1956
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 23469103T00000X, 103TA0700X, 103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent