Provider Demographics
NPI:1841412517
Name:HOLAHAN, LINDA (EDD, MSN, CS, LP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:HOLAHAN
Suffix:
Gender:F
Credentials:EDD, MSN, CS, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 W END AVE
Mailing Address - Street 2:17F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5401
Mailing Address - Country:US
Mailing Address - Phone:212-724-3854
Mailing Address - Fax:
Practice Address - Street 1:140 W 86TH ST
Practice Address - Street 2:1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4034
Practice Address - Country:US
Practice Address - Phone:212-721-4765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000796102L00000X
NY195568163WP0809X
NY196658364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR2C431Medicare ID - Type Unspecified
NYR2C431Medicare PIN