Provider Demographics
NPI:1649655754
Name:HOLMES, JEFFREY (PHD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:HOLMES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2603
Mailing Address - Country:US
Mailing Address - Phone:607-737-1235
Mailing Address - Fax:607-735-9617
Practice Address - Street 1:410 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2603
Practice Address - Country:US
Practice Address - Phone:607-737-1235
Practice Address - Fax:607-735-9617
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020220103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist