Provider Demographics
NPI:1619372174
Name:LITTMAN, PHYLLIS
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:LITTMAN
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 1:45 CREEKSIDE LANE
Mailing Address - Street 2:APARTMENT 315
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355
Mailing Address - Country:US
Mailing Address - Phone:610-935-2770
Mailing Address - Fax:
Practice Address - Street 1:45 CREEKSIDE LN
Practice Address - Street 2:APARTMENT 315
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3217
Practice Address - Country:US
Practice Address - Phone:610-935-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0120211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical