Provider Demographics
NPI:1255677522
Name:PHILLIPS, HAROLD (MED)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 WOOD AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3823
Mailing Address - Country:US
Mailing Address - Phone:617-308-0944
Mailing Address - Fax:617-276-3067
Practice Address - Street 1:1960 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3219
Practice Address - Country:US
Practice Address - Phone:617-516-0280
Practice Address - Fax:617-516-0281
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health