Provider Demographics
NPI:1831659911
Name:CUTTER-HUMPHREY, PHILIPPA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:PHILIPPA
Middle Name:
Last Name:CUTTER-HUMPHREY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 LIATRIS LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-6593
Mailing Address - Country:US
Mailing Address - Phone:919-601-8671
Mailing Address - Fax:
Practice Address - Street 1:5613 DURALEIGH RD STE 161
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2709
Practice Address - Country:US
Practice Address - Phone:919-784-0205
Practice Address - Fax:919-784-0250
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-23
Last Update Date:2019-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC010946101YM0800X
NCCO109461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health