Provider Demographics
NPI:1144987868
Name:HOLDER, HAROLD (BA PSYCH, BSW, MSW)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:HOLDER
Suffix:
Gender:M
Credentials:BA PSYCH, BSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 GLENMOSE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3865
Mailing Address - Country:US
Mailing Address - Phone:158-551-0962
Mailing Address - Fax:
Practice Address - Street 1:2800 JOE DIMAGGIO BLVD UNIT 40
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-3951
Practice Address - Country:US
Practice Address - Phone:585-510-9625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
8044261041C0700X
NY21230609101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)