Provider Demographics
NPI:1477177426
Name:SLOATE, PHYLLIS L (PHD)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:L
Last Name:SLOATE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 AVIS DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-3004
Mailing Address - Country:US
Mailing Address - Phone:914-636-2833
Mailing Address - Fax:
Practice Address - Street 1:30 AVIS DRIVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-3004
Practice Address - Country:US
Practice Address - Phone:914-636-2833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007120-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty