Provider Demographics
NPI:1811258833
Name:PHILLIPS, DENORA CHRISTIAN (MS ED, ABA)
Entity type:Individual
Prefix:MRS
First Name:DENORA
Middle Name:CHRISTIAN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS ED, ABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 W 21ST ST
Mailing Address - Street 2:SUITE 701
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6805
Mailing Address - Country:US
Mailing Address - Phone:347-675-3044
Mailing Address - Fax:
Practice Address - Street 1:19 W 21ST ST
Practice Address - Street 2:SUITE 701
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6805
Practice Address - Country:US
Practice Address - Phone:347-675-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36784061174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist