Provider Demographics
NPI:1790839447
Name:HOLLER-KENNEDY, GAIL E (LMHC)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:E
Last Name:HOLLER-KENNEDY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 NIAGARA FALLS BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-6494
Mailing Address - Country:US
Mailing Address - Phone:716-200-9448
Mailing Address - Fax:
Practice Address - Street 1:7348 BEAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-9520
Practice Address - Country:US
Practice Address - Phone:716-200-9448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000506354005OtherCOMMUNITY BLUE
NY00030241501OtherUNIVERA
NY091202000104OtherFIDELIS