Provider Demographics
NPI:1578902748
Name:PHILLIPS, JOAN CATHERINE
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:CATHERINE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RUGBY RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3704
Mailing Address - Country:US
Mailing Address - Phone:516-236-3922
Mailing Address - Fax:
Practice Address - Street 1:28 MERRICK AVE
Practice Address - Street 2:STE 9E
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3433
Practice Address - Country:US
Practice Address - Phone:516-236-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)