Provider Demographics
NPI:1841913688
Name:PHILLIPS, AMENEYA O (LMFT)
Entity type:Individual
Prefix:MS
First Name:AMENEYA
Middle Name:O
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 BIRDSEYE ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-6976
Mailing Address - Country:US
Mailing Address - Phone:203-368-4095
Mailing Address - Fax:
Practice Address - Street 1:468 BIRDSEYE ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-6976
Practice Address - Country:US
Practice Address - Phone:203-368-4095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002926106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist