Provider Demographics
NPI:1306045216
Name:PHILLIPS, STEVEN J (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 SUMMERVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-1805
Mailing Address - Country:US
Mailing Address - Phone:845-591-7505
Mailing Address - Fax:845-508-6253
Practice Address - Street 1:2002 ROUTE 17M
Practice Address - Street 2:SUITE #1. MAILBOX #5
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-5235
Practice Address - Country:US
Practice Address - Phone:845-591-7505
Practice Address - Fax:845-508-6253
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002305101YM0800X
NC11127101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11764609OtherCAQH