Provider Demographics
NPI:1093854770
Name:PHILLIPS, RICHARD (MS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 FARRAGUT ST
Mailing Address - Street 2:UNIT 5E
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3118
Mailing Address - Country:US
Mailing Address - Phone:954-987-0714
Mailing Address - Fax:
Practice Address - Street 1:601 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-4054
Practice Address - Country:US
Practice Address - Phone:954-321-2296
Practice Address - Fax:954-321-5399
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS 583103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool