1396332862 NPI number — CAELAN HOLCOMBE MHC-LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396332862 NPI number — CAELAN HOLCOMBE MHC-LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLCOMBE
Provider First Name:
CAELAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MHC-LP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396332862
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38 JERSEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14609-7222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-489-8960
Provider Business Mailing Address Fax Number:
844-792-1833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 HYLAN DR STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14623-4216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-201-8418
Provider Business Practice Location Address Fax Number:
844-792-8133
Provider Enumeration Date:
12/30/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  P107024 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 013063 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 013063 . This is a "DIVISION OF PROFESSIONAL LICENSING SERVICES" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P107024 . This is a "DIVISION OF PROFESSIONAL LICENSING SERVICES" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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