Provider Demographics
NPI:1972805794
Name:HOLT, LEROY ALLEN
Entity Type:Individual
Prefix:MR
First Name:LEROY
Middle Name:ALLEN
Last Name:HOLT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POST OFFICE BOX 40
Mailing Address - Street 2:21 BAKER STREET
Mailing Address - City:CLINTON
Mailing Address - State:ME
Mailing Address - Zip Code:04927-0040
Mailing Address - Country:US
Mailing Address - Phone:207-426-8979
Mailing Address - Fax:
Practice Address - Street 1:21 BAKER STREET
Practice Address - Street 2:40
Practice Address - City:CLINTON
Practice Address - State:ME
Practice Address - Zip Code:04927-0040
Practice Address - Country:US
Practice Address - Phone:207-426-8979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator