Provider Demographics
NPI:1548585177
Name:HOLTZ, SALLY B (PHD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:B
Last Name:HOLTZ
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 1:410 GREAT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1716
Mailing Address - Country:US
Mailing Address - Phone:610-525-4228
Mailing Address - Fax:610-525-1905
Practice Address - Street 1:410 GREAT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1716
Practice Address - Country:US
Practice Address - Phone:610-525-4228
Practice Address - Fax:610-525-1905
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003430L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical