Provider Demographics
NPI:1558599027
Name:HOLDER, LAMORN (MS, CDN)
Entity Type:Individual
Prefix:MRS
First Name:LAMORN
Middle Name:
Last Name:HOLDER
Suffix:
Gender:F
Credentials:MS, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 STEVENS AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550
Mailing Address - Country:US
Mailing Address - Phone:914-668-0808
Mailing Address - Fax:914-668-0629
Practice Address - Street 1:153 STEVENS AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:MT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550
Practice Address - Country:US
Practice Address - Phone:914-668-0808
Practice Address - Fax:914-668-0629
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004333-1133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist