Provider Demographics
NPI:1578734083
Name:PHILLIPS, STEPHEN WILLIAM (LSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:WILLIAM
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 WEST AVE., 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-3350
Mailing Address - Country:US
Mailing Address - Phone:610-909-0096
Mailing Address - Fax:
Practice Address - Street 1:1109 WEST AVE., 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-3350
Practice Address - Country:US
Practice Address - Phone:610-909-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW122717104100000X
NJ44SL05266800104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker