Provider Demographics
NPI:1861909442
Name:HOLMES, MARY KATHLEEN (FPA)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHLEEN
Last Name:HOLMES
Suffix:
Gender:F
Credentials:FPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 W BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-1210
Mailing Address - Country:US
Mailing Address - Phone:585-786-5908
Mailing Address - Fax:585-786-3739
Practice Address - Street 1:96 W BUFFALO ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1210
Practice Address - Country:US
Practice Address - Phone:585-786-5908
Practice Address - Fax:585-786-3739
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist