Provider Demographics
NPI:1386831816
Name:WRIGHT, PHYLLIS PATRICIA (MSW)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:PATRICIA
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 CENTRAL PARK W
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4530
Mailing Address - Country:US
Mailing Address - Phone:212-724-8760
Mailing Address - Fax:212-721-2852
Practice Address - Street 1:241 CENTRAL PARK W
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4530
Practice Address - Country:US
Practice Address - Phone:212-724-8760
Practice Address - Fax:212-721-2852
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0238081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN76721Medicare PIN