Provider Demographics
NPI:1083868210
Name:PHILLIPS, NANCY KATHARINE
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:KATHARINE
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 1:500 W CUMMINGS PARK
Mailing Address - Street 2:STE 3900
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6503
Mailing Address - Country:US
Mailing Address - Phone:781-932-8114
Mailing Address - Fax:
Practice Address - Street 1:500 W CUMMINGS PARK
Practice Address - Street 2:STE 3900
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6503
Practice Address - Country:US
Practice Address - Phone:781-932-8114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110940101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health