Provider Demographics
NPI:1417219882
Name:HOLMES, ALICIA A (MSED)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:A
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MISS
Other - First Name:ALICIA
Other - Middle Name:A
Other - Last Name:SHELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:44 PARROTT PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3515
Mailing Address - Country:US
Mailing Address - Phone:718-913-4833
Mailing Address - Fax:
Practice Address - Street 1:420 95TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7404
Practice Address - Country:US
Practice Address - Phone:718-680-9751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist