1306045216 NPI number — STEVEN J PHILLIPS MA, LMHC

Table of content: STEVEN J PHILLIPS MA, LMHC (NPI 1306045216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306045216 NPI number — STEVEN J PHILLIPS MA, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS
Provider First Name:
STEVEN
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LMHC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306045216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4228 SUMMERVILLE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10918-1805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-591-7505
Provider Business Mailing Address Fax Number:
845-508-6253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2002 ROUTE 17M
Provider Second Line Business Practice Location Address:
SUITE #1. MAILBOX #5
Provider Business Practice Location Address City Name:
GOSHEN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10924-5235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-591-7505
Provider Business Practice Location Address Fax Number:
845-508-6253
Provider Enumeration Date:
07/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  002305 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: 11127 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11764609 . This is a "CAQH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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