Provider Demographics
NPI:1700266830
Name:HOLZMAN, KATHLEEN MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MICHELLE
Last Name:HOLZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:MICHELLE
Other - Last Name:EASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3206 TENNESSEE ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-2435
Mailing Address - Country:US
Mailing Address - Phone:505-450-8870
Mailing Address - Fax:
Practice Address - Street 1:3206 TENNESSEE ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2435
Practice Address - Country:US
Practice Address - Phone:505-450-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor