Provider Demographics
NPI:1821217175
Name:HOLTZMAN, ELLEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:HOLTZMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-4839
Mailing Address - Country:US
Mailing Address - Phone:781-665-8164
Mailing Address - Fax:
Practice Address - Street 1:16 BROAD ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-2011
Practice Address - Country:US
Practice Address - Phone:603-889-8781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH579103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80002457Medicaid
NHRE2457Medicare ID - Type Unspecified