Provider Demographics
NPI:1184500159
Name:HOLMAN, BROOKE GWYNETH DAWN
Entity type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:GWYNETH DAWN
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-3011
Mailing Address - Country:US
Mailing Address - Phone:617-864-8140
Mailing Address - Fax:
Practice Address - Street 1:186 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-3011
Practice Address - Country:US
Practice Address - Phone:617-864-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator