1861436784 NPI number — MS. ELAINE PHILLIPS LPC

Table of content: MS. ELAINE PHILLIPS LPC (NPI 1861436784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861436784 NPI number — MS. ELAINE PHILLIPS LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS
Provider First Name:
ELAINE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

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:
1861436784
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 MILL PLAIN RD
Provider Second Line Business Mailing Address:
STE 366
Provider Business Mailing Address City Name:
DAUBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06811-5178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-791-3828
Provider Business Mailing Address Fax Number:
203-791-3885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MILL PLAIN RD
Provider Second Line Business Practice Location Address:
STE 366
Provider Business Practice Location Address City Name:
DAUBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06811-5178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-791-3828
Provider Business Practice Location Address Fax Number:
203-791-3885
Provider Enumeration Date:
06/15/2006

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: 101Y00000X , with the licence number:  000647 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P2134362 . This is a "OXFORD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: PHILELAN . This is a "CORP HEALTH INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 240000647CT01 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5887739 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: PIN309006 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: IP556121 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier . This identifiers is of the category "OTHER".




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