Provider Demographics
NPI:1689480105
Name:HOLMES, PEARL ELIZABETH (RBT)
Entity type:Individual
Prefix:
First Name:PEARL
Middle Name:ELIZABETH
Last Name:HOLMES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 W PORTAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1407
Mailing Address - Country:US
Mailing Address - Phone:415-994-0642
Mailing Address - Fax:
Practice Address - Street 1:139 HUGO ST APT 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2760
Practice Address - Country:US
Practice Address - Phone:415-994-0642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-22-245126106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician