1700111325 NPI number — MRS. CATHERINE MURIEL HOLLOWAY LCPC

Table of content: MRS. CATHERINE MURIEL HOLLOWAY LCPC (NPI 1700111325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700111325 NPI number — MRS. CATHERINE MURIEL HOLLOWAY LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLOWAY
Provider First Name:
CATHERINE
Provider Middle Name:
MURIEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLLOWAY
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1700111325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 HOOPER ST.
Provider Second Line Business Mailing Address:
UMBRELLA MENTAL HEALTH SERVICES
Provider Business Mailing Address City Name:
WISCASSET
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-687-2180
Provider Business Mailing Address Fax Number:
207-687-2181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1604 BENTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04901-3327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-453-4708
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2009

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: 101YP2500X , with the licence number:  CC2956 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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