Provider Demographics
NPI:1952492167
Name:HOLBROOK, JAMES W (EDD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:HOLBROOK
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:W
Other - Last Name:HOLBROOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:3706 N ROOSEVELT BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4566
Mailing Address - Country:US
Mailing Address - Phone:305-294-1277
Mailing Address - Fax:305-294-8927
Practice Address - Street 1:3706 N ROOSEVELT BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4566
Practice Address - Country:US
Practice Address - Phone:305-294-1277
Practice Address - Fax:305-294-8927
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003968103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73750Medicare ID - Type Unspecified