Provider Demographics
NPI:1710996822
Name:HOLLENBECK, M. ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:M.
Middle Name:ELIZABETH
Last Name:HOLLENBECK
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 1:155 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3131
Mailing Address - Country:US
Mailing Address - Phone:603-283-0195
Mailing Address - Fax:
Practice Address - Street 1:155 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3131
Practice Address - Country:US
Practice Address - Phone:603-283-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPSY538103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHPSY538OtherPSYCHOLOGIST LICENSE #
NH81263595Medicaid
NHS79629Medicare UPIN