Provider Demographics
NPI:1073565701
Name:PHILIPS, JANET SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:SUSAN
Last Name:PHILIPS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24050 MADISON STREET 100P
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6080
Mailing Address - Country:US
Mailing Address - Phone:310-373-1725
Mailing Address - Fax:310-373-1916
Practice Address - Street 1:24050 MADISON STREET 100P
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6080
Practice Address - Country:US
Practice Address - Phone:310-373-1725
Practice Address - Fax:310-373-1916
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14185103TC0700X
CAPSY14185103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP14185Medicare ID - Type Unspecified
CAR95033Medicare UPIN