Provider Demographics
NPI:1023212594
Name:PHILLIPS, PEPPER ELLEN
Entity Type:Individual
Prefix:DR
First Name:PEPPER
Middle Name:ELLEN
Last Name:PHILLIPS
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 1:1122 SHOEMAKER BLDG
Mailing Address - Street 2:UNIVERSITY OF MARYLAND
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20742-8101
Mailing Address - Country:US
Mailing Address - Phone:301-314-7672
Mailing Address - Fax:301-314-9206
Practice Address - Street 1:1122 SHOEMAKER BLDG
Practice Address - Street 2:UNIVERSITY OF MARYLAND
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20742-8101
Practice Address - Country:US
Practice Address - Phone:301-314-7672
Practice Address - Fax:301-314-9206
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2748103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist