Provider Demographics
NPI:1790355394
Name:PHILLIPS, MEGAN MICHELLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MICHELLE
Last Name:PHILLIPS
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 1:919 POTOMAC AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3430
Mailing Address - Country:US
Mailing Address - Phone:814-873-9541
Mailing Address - Fax:
Practice Address - Street 1:12634 ANGLING RD STE F
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-1369
Practice Address - Country:US
Practice Address - Phone:814-250-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0219261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical