Provider Demographics
NPI:1528182490
Name:CRAIG, PHYLLIS LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:LEE
Last Name:CRAIG
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 1:14 FRONT ST STE 11
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2781
Mailing Address - Country:US
Mailing Address - Phone:603-418-7073
Mailing Address - Fax:603-418-7033
Practice Address - Street 1:14 FRONT ST STE 11
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2781
Practice Address - Country:US
Practice Address - Phone:603-418-7073
Practice Address - Fax:603-418-7033
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH 1033103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1669842183OtherNPPES