Provider Demographics
NPI:1982141016
Name:PHILLIPS, PATRICIA ALDEN (COTA/L, BAP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ALDEN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:COTA/L, BAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 STONEWALL AVE
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-5318
Mailing Address - Country:US
Mailing Address - Phone:774-929-5555
Mailing Address - Fax:
Practice Address - Street 1:30 STONEWALL AVE
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-5318
Practice Address - Country:US
Practice Address - Phone:774-929-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1201101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor