Provider Demographics
NPI:1932628963
Name:PHIPPS, CARRISSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARRISSA
Middle Name:
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CARRISSA
Other - Middle Name:LYNN
Other - Last Name:PHILLIPPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:424 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2633
Mailing Address - Country:US
Mailing Address - Phone:860-740-2041
Mailing Address - Fax:
Practice Address - Street 1:360 MAIN ST STE 2D
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3375
Practice Address - Country:US
Practice Address - Phone:860-248-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3682103T00000X
NY022247-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist