Provider Demographics
NPI:1184834020
Name:PHILLIPS, THOMAS A (MA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:A
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:13865-4322
Mailing Address - Country:US
Mailing Address - Phone:607-655-4040
Mailing Address - Fax:
Practice Address - Street 1:20 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:13865-4322
Practice Address - Country:US
Practice Address - Phone:607-655-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000153106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist