Provider Demographics
NPI:1750354684
Name:HOLMES, BRUCE WAYNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WAYNE
Last Name:HOLMES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FIRST MONTGOMERY DRIVE
Mailing Address - Street 2:35-B
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060
Mailing Address - Country:US
Mailing Address - Phone:609-562-5670
Mailing Address - Fax:
Practice Address - Street 1:5250 NEW JERSEY AVE
Practice Address - Street 2:
Practice Address - City:FORT DIX
Practice Address - State:NJ
Practice Address - Zip Code:08640-5017
Practice Address - Country:US
Practice Address - Phone:609-562-5670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016052103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical