Provider Demographics
NPI:1639418577
Name:HOLICK, GINA MARIE
Entity Type:Individual
Prefix:MISS
First Name:GINA
Middle Name:MARIE
Last Name:HOLICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 PLEASANT ST STE 115
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2570
Mailing Address - Country:US
Mailing Address - Phone:508-223-4691
Mailing Address - Fax:508-223-3397
Practice Address - Street 1:607 PLEASANT ST STE 115
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2570
Practice Address - Country:US
Practice Address - Phone:508-223-4691
Practice Address - Fax:508-223-3397
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS54295914390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program