Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | NY | |
Y | 103T00000X | Psychologist | NY |
NPI | 1003583725 |
---|---|
Provider Name | Jason Holloway |
First Address | Brooklyn, NY 11238-4271 |
Second Address | Brooklyn, NY 11238-4271 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2021 |
Last Update Date | 30/08/2021 |