Provider Demographics
NPI:1881748044
Name:PHIPPS, PATRICK (PSYD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:PHIPPS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-4226
Mailing Address - Country:US
Mailing Address - Phone:954-214-9299
Mailing Address - Fax:954-925-9333
Practice Address - Street 1:624 W TROPICAL WAY
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-3348
Practice Address - Country:US
Practice Address - Phone:954-584-6155
Practice Address - Fax:954-316-7553
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6402103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical