Provider Demographics
NPI:1598796336
Name:PHIPPS, ARLENE M (LCSW)
Entity Type:Individual
Prefix:DR
First Name:ARLENE
Middle Name:M
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 CLAREMONT AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5700
Mailing Address - Country:US
Mailing Address - Phone:209-472-3627
Mailing Address - Fax:209-472-3626
Practice Address - Street 1:5250 CLAREMONT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5700
Practice Address - Country:US
Practice Address - Phone:209-472-3627
Practice Address - Fax:209-472-3626
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS87891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMMM00178MMedicare ID - Type Unspecified