Individual
IVANNA HOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2037 UTICA AVE, BROOKLYN, NY 11234-3215
(718) 377-5755
Mailing address
2037 UTICA AVE, BROOKLYN, NY 11234-3215
(718) 377-5755
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/12/2018
Last updated
04/12/2018
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