Provider Demographics
NPI:1669695474
Name:PHILLIPS, DENISE JEAN (MSW, PHD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:JEAN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MSW, PHD
Other - Prefix:DR
Other - First Name:DENISE
Other - Middle Name:JEAN
Other - Last Name:PHILLIPS, PH.D
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, PHD
Mailing Address - Street 1:43 E 10TH ST
Mailing Address - Street 2:APT 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6101
Mailing Address - Country:US
Mailing Address - Phone:212-780-9852
Mailing Address - Fax:212-780-9852
Practice Address - Street 1:43 EAST 10TH STREET
Practice Address - Street 2:APT 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-780-9852
Practice Address - Fax:212-780-9852
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO197661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical