Provider Demographics
NPI:1982731808
Name:PHILLIPPS, RICHARD L (LICSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:PHILLIPPS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 DICKERMAN RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1304
Mailing Address - Country:US
Mailing Address - Phone:617-332-6524
Mailing Address - Fax:617-332-1652
Practice Address - Street 1:136 DICKERMAN RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-1304
Practice Address - Country:US
Practice Address - Phone:617-332-6524
Practice Address - Fax:617-332-1652
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10171621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical