Provider Demographics
NPI:1679639181
Name:PHILLIPS, PATRICIA I (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:I
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-0095
Mailing Address - Country:US
Mailing Address - Phone:518-213-0427
Mailing Address - Fax:
Practice Address - Street 1:81 MILLER RD
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-4035
Practice Address - Country:US
Practice Address - Phone:518-213-0427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035501-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY035501-1OtherLCSW-R