Provider Demographics
NPI:1881477461
Name:HOLDEN, CARLI R
Entity type:Individual
Prefix:
First Name:CARLI
Middle Name:R
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 WASHINGTON BLVD APT 327
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-8812
Mailing Address - Country:US
Mailing Address - Phone:732-406-6740
Mailing Address - Fax:
Practice Address - Street 1:1201 WASHINGTON BLVD APT 327
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-8812
Practice Address - Country:US
Practice Address - Phone:732-406-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist