Provider Demographics
NPI:1821291972
Name:PHILLIPS, SARA CIMO (PH D)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:CIMO
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2991 FRIENDS RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7221
Mailing Address - Country:US
Mailing Address - Phone:410-266-0740
Mailing Address - Fax:410-571-8565
Practice Address - Street 1:2991 FRIENDS RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7221
Practice Address - Country:US
Practice Address - Phone:410-266-0740
Practice Address - Fax:410-571-8565
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2235103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist