Provider Demographics
NPI:1902175557
Name:HOLMES, TAMARA C (DSW, LCSW)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:C
Last Name:HOLMES
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:892 E 167TH ST # 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-2309
Mailing Address - Country:US
Mailing Address - Phone:917-544-0451
Mailing Address - Fax:
Practice Address - Street 1:3444 KOSSUTH AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2410
Practice Address - Country:US
Practice Address - Phone:718-920-2273
Practice Address - Fax:718-920-4828
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0936751041C0700X
NY084869104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker