Provider Demographics
NPI:1366452468
Name:PHILLIPS, STEPHANIE KIM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:KIM
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JIN
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:10475 PERRY HWY
Mailing Address - Street 2:TOWN CENTRE, STE 300
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9274
Mailing Address - Country:US
Mailing Address - Phone:724-759-7500
Mailing Address - Fax:724-759-7600
Practice Address - Street 1:10475 PERRY HWY
Practice Address - Street 2:TOWN CENTRE, STE 300
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9274
Practice Address - Country:US
Practice Address - Phone:724-759-7500
Practice Address - Fax:724-759-7600
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009055L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical