Provider Demographics
NPI:1598486185
Name:PHILLIPS-MADRIGAL, CATHERINE ALLISON (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ALLISON
Last Name:PHILLIPS-MADRIGAL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:CATHERINE
Other - Middle Name:ALLISON
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 W MAGNOLIA AVE APT 239
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7689
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 E DEBBIE LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2924
Practice Address - Country:US
Practice Address - Phone:540-847-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108594104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker