Provider Demographics
NPI:1902194913
Name:PHILLIPS, BRIANA CAPRICE (MA)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:CAPRICE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 MARY ST FL 1
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2006
Mailing Address - Country:US
Mailing Address - Phone:267-632-3153
Mailing Address - Fax:484-462-3575
Practice Address - Street 1:3322 MARY ST FL 1
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2006
Practice Address - Country:US
Practice Address - Phone:856-210-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA26513776101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health