Provider Demographics
NPI:1215002100
Name:PHILIPS, SANDRA FORTIER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:FORTIER
Last Name:PHILIPS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WEST THAMES STREET
Mailing Address - Street 2:SOUTHEASTERN MENTAL HEALTH AUTHORITY BLDG 301
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-859-4674
Mailing Address - Fax:860-859-4790
Practice Address - Street 1:401 WEST THAMES STREET
Practice Address - Street 2:SOUTHEASTERN MENTAL HEALTH AUTHORITY BLDG 301
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-859-4674
Practice Address - Fax:860-859-4790
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0031121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical