Provider Demographics
NPI:1023578580
Name:PHILLIPS, PATRICK MATTHEW
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:MATTHEW
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 REINER ST
Mailing Address - Street 2:
Mailing Address - City:COLMA
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2559
Mailing Address - Country:US
Mailing Address - Phone:650-994-3583
Mailing Address - Fax:
Practice Address - Street 1:85 REINER ST
Practice Address - Street 2:
Practice Address - City:COLMA
Practice Address - State:CA
Practice Address - Zip Code:94014-2559
Practice Address - Country:US
Practice Address - Phone:650-994-3583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health