Provider Demographics
NPI:1396071999
Name:HOLMES, CAMILLE V (CCC SLP/ MHC)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:V
Last Name:HOLMES
Suffix:
Gender:F
Credentials:CCC SLP/ MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 RATHBUN AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-3010
Mailing Address - Country:US
Mailing Address - Phone:914-774-2503
Mailing Address - Fax:
Practice Address - Street 1:55 RATHBUN AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10606-3010
Practice Address - Country:US
Practice Address - Phone:347-638-2765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019454-1235Z00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1222130OtherINITIAL CERTIFICATION