Provider Demographics
NPI:1891898037
Name:HOLCOMB, LAURA (PH D)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CHASE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4624
Mailing Address - Country:US
Mailing Address - Phone:207-872-4451
Mailing Address - Fax:207-872-4287
Practice Address - Street 1:30 CHASE AVE
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4624
Practice Address - Country:US
Practice Address - Phone:207-872-4451
Practice Address - Fax:207-872-4287
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1070103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM9642Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER