Provider Demographics
NPI:1992842405
Name:HOLLYER, LAURAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURAINE
Middle Name:
Last Name:HOLLYER
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 1:185 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2605
Mailing Address - Country:US
Mailing Address - Phone:973-748-7644
Mailing Address - Fax:973-748-9364
Practice Address - Street 1:185 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2605
Practice Address - Country:US
Practice Address - Phone:973-748-7644
Practice Address - Fax:973-748-9364
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2440103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
075659Medicare ID - Type Unspecified