Provider Demographics
NPI:1003932799
Name:PHILLIPS, JANET PATRICIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:PATRICIA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 135
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-0135
Mailing Address - Country:US
Mailing Address - Phone:619-542-5267
Mailing Address - Fax:619-692-8779
Practice Address - Street 1:1250 MORENA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3815
Practice Address - Country:US
Practice Address - Phone:619-542-5267
Practice Address - Fax:619-692-8779
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS243241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical