Provider Demographics
NPI:1336294206
Name:PHILIPPOU, CHRYSOULA S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRYSOULA
Middle Name:S
Last Name:PHILIPPOU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 OCEAN AVE
Mailing Address - Street 2:APT. 14 H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3971
Mailing Address - Country:US
Mailing Address - Phone:718-338-4652
Mailing Address - Fax:718-338-4652
Practice Address - Street 1:1401 OCEAN AVE
Practice Address - Street 2:SUITE LH
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3971
Practice Address - Country:US
Practice Address - Phone:718-338-4652
Practice Address - Fax:718-338-4652
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013881-1103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVD7121Medicare ID - Type Unspecified