Provider Demographics
NPI:1942434600
Name:PHILLIPS, RUBY SARA (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUBY
Middle Name:SARA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 ROSEMARIE LANE
Mailing Address - Street 2:638
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-8243
Mailing Address - Country:US
Mailing Address - Phone:209-952-8331
Mailing Address - Fax:
Practice Address - Street 1:2317 ROSEMARIE LANE
Practice Address - Street 2:# 638
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8243
Practice Address - Country:US
Practice Address - Phone:209-952-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent