Provider Demographics
NPI:1578136040
Name:PHILLIPS, MARIA (MA, NCC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-1547
Mailing Address - Country:US
Mailing Address - Phone:856-381-7063
Mailing Address - Fax:
Practice Address - Street 1:1226 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-3160
Practice Address - Country:US
Practice Address - Phone:215-450-5271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health