Provider Demographics
NPI:1356420939
Name:HOLDERLE, KRISTEN ELAINE (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:ELAINE
Last Name:HOLDERLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:HOLDERLE
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1175 PITTSFORD VICTOR RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3811
Mailing Address - Country:US
Mailing Address - Phone:585-797-7084
Mailing Address - Fax:844-626-2450
Practice Address - Street 1:1175 PITTSFORD VICTOR RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3811
Practice Address - Country:US
Practice Address - Phone:585-797-7084
Practice Address - Fax:844-626-2450
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16808103T00000X
NY016808103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY18954FCOtherPREFERRED CARE
NY7161860OtherAETNA
NYP010016808OtherEXCELLUS ROCHESTER REGION