Provider Demographics
NPI:1922373208
Name:PHILLA, DONALD E (BA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:PHILLA
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 EVERGREEN ST # T
Mailing Address - Street 2:
Mailing Address - City:SOUTH YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-5611
Mailing Address - Country:US
Mailing Address - Phone:508-760-8286
Mailing Address - Fax:
Practice Address - Street 1:49 EVERGREEN ST # T
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-5611
Practice Address - Country:US
Practice Address - Phone:508-760-8286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health