Provider Demographics
NPI:1710250279
Name:PHILLIPS, PATRICIA (LCSW, MSSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCSW, MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 SOUTH ORANGE AV
Mailing Address - Street 2:GULF COAST HEALTHCARE SERVICES, INC.
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2036
Mailing Address - Country:US
Mailing Address - Phone:941-954-8725
Mailing Address - Fax:
Practice Address - Street 1:2055 WOOD ST
Practice Address - Street 2:STE 220
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237
Practice Address - Country:US
Practice Address - Phone:941-366-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW5753104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker