Provider Demographics
NPI:1689723488
Name:PHILLIPS, LLOYD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LLOYD
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1403
Mailing Address - Country:US
Mailing Address - Phone:516-764-1257
Mailing Address - Fax:
Practice Address - Street 1:26 ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1403
Practice Address - Country:US
Practice Address - Phone:516-764-1257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR025155-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY136868OtherVALUE OPTIONS PIN
NY7478952OtherGHI PIN