Healthcare Provider Details

I. General information

NPI: 1992011415
Provider Name (Legal Business Name): LAURA KATHRYN PHILLIPS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2010
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 CONCORD AVE
CAMBRIDGE MA
02138-1040
US

IV. Provider business mailing address

30 HAMILTON RD APT 204
ARLINGTON MA
02474-8272
US

V. Phone/Fax

Practice location:
  • Phone: 781-999-0640
  • Fax:
Mailing address:
  • Phone: 781-999-0640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number9277
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: