Provider Demographics
NPI:1942634407
Name:HOLLY, SHAREEN (PHD)
Entity Type:Individual
Prefix:
First Name:SHAREEN
Middle Name:
Last Name:HOLLY
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 1:50 MAUDE ST
Mailing Address - Street 2:ELMHURST EXTENDED BLDG, 5TH FL
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-4325
Mailing Address - Country:US
Mailing Address - Phone:401-456-6587
Mailing Address - Fax:401-456-2399
Practice Address - Street 1:50 MAUDE ST
Practice Address - Street 2:ELMHURST EXTENDED BLDG, 5TH FL
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4325
Practice Address - Country:US
Practice Address - Phone:401-456-6587
Practice Address - Fax:401-456-2399
Is Sole Proprietor?:No
Enumeration Date:2013-09-02
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01395103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent