Basic Information
| Provider Information | |||||||||
| NPI: | 1831860188 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHINNEY | ||||||||
| FirstName: | WALTER | ||||||||
| MiddleName: | JOHN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 CONIFER LN | ||||||||
| Address2: | |||||||||
| City: | SOUTH DENNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026603628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083649301 | ||||||||
| FaxNumber: | 5087715400 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 BARNSTABLE RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026012902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088620514 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2021 | ||||||||
| LastUpdateDate: | 09/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.