Provider Demographics
NPI:1770095200
Name:HOLMES, DORIS JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:DORIS
Middle Name:JEAN
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-4005
Mailing Address - Country:US
Mailing Address - Phone:215-408-4977
Mailing Address - Fax:215-408-4951
Practice Address - Street 1:499 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-4005
Practice Address - Country:US
Practice Address - Phone:215-408-4977
Practice Address - Fax:215-408-4951
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
PAPS-005806-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist