Healthcare Provider Details

I. General information

NPI: 1477367886
Provider Name (Legal Business Name): JULIA C PHILLIPS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GRAND ST
NEW BRITAIN CT
06052-2016
US

IV. Provider business mailing address

237 TOWN COLONY DR
MIDDLETOWN CT
06457-5904
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-5900
  • Fax:
Mailing address:
  • Phone: 203-530-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number013248
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: