Provider Demographics
NPI:1497112577
Name:HOLTZMAN, ELIZABETH GIBBONS (PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GIBBONS
Last Name:HOLTZMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 DOYLSTON DR
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3425
Mailing Address - Country:US
Mailing Address - Phone:401-345-2677
Mailing Address - Fax:
Practice Address - Street 1:1035 POST RD
Practice Address - Street 2:STRATEGIC PSYCHOLOGICAL SERVICES
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3363
Practice Address - Country:US
Practice Address - Phone:401-785-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00940103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist