Provider Demographics
NPI:1518404359
Name:PHILLIPS, AMANDA (LSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 LAKESIDE OFFICE PARK
Mailing Address - Street 2:SUITE 504
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966
Mailing Address - Country:US
Mailing Address - Phone:215-354-0777
Mailing Address - Fax:
Practice Address - Street 1:504 LAKESIDE OFFICE PARK
Practice Address - Street 2:SUITE 504
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966
Practice Address - Country:US
Practice Address - Phone:215-354-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1289421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical