Basic Information
| Provider Information | |||||||||
| NPI: | 1023164829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 6762 BRANT DR | ||||||||
| Address2: | |||||||||
| City: | MERCERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172369771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017306200 | ||||||||
| FaxNumber: | 4109383410 | ||||||||
| Practice Location | |||||||||
| Address1: | 8504 MAPLEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BOONSBORO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017339067 | ||||||||
| FaxNumber: | 3017334980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 08/01/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 10025 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.