Basic Information
Provider Information | |||||||||
NPI: | 1801105739 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOLLEY | ||||||||
FirstName: | CAITLIN | ||||||||
MiddleName: | KILLELEA | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PH.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 57 HARMON RD | ||||||||
Address2: |   | ||||||||
City: | GLENVILLE | ||||||||
State: | NY | ||||||||
PostalCode: | 123025400 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5184614685 | ||||||||
FaxNumber: | 5186265407 | ||||||||
Practice Location | |||||||||
Address1: | 113 HOLLAND AVE | ||||||||
Address2: | MAILCODE 116A | ||||||||
City: | ALBANY | ||||||||
State: | NY | ||||||||
PostalCode: | 122083410 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5186265365 | ||||||||
FaxNumber: | 5186265407 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/27/2010 | ||||||||
LastUpdateDate: | 09/27/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 018744 | NY | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.