Provider Demographics
NPI:1811441249
Name:MCGILL, PHYLLIS LAUREN (PHD)
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:LAUREN
Last Name:MCGILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:PHYLLIS
Other - Middle Name:LAUREN
Other - Last Name:SPIEGEL-MCGILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:8A ASPEN RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-5618
Mailing Address - Country:US
Mailing Address - Phone:518-495-4517
Mailing Address - Fax:
Practice Address - Street 1:8A ASPEN RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-5618
Practice Address - Country:US
Practice Address - Phone:518-495-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator