Healthcare Provider Details

I. General information

NPI: 1154383057
Provider Name (Legal Business Name): ARIEL INGRID AINO PHILLIPS ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LINDEN ST
CAMBRIDGE MA
02138-5004
US

IV. Provider business mailing address

5 LINDEN ST
CAMBRIDGE MA
02138-5004
US

V. Phone/Fax

Practice location:
  • Phone: 617-495-2581
  • Fax: 617-495-7680
Mailing address:
  • Phone: 617-495-2581
  • Fax: 617-495-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6942
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6942
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: