Healthcare Provider Details

I. General information

NPI: 1841632767
Provider Name (Legal Business Name): PAUL MATTHEW PHILLIPS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10819 ROCKAWAY BLVD
SOUTH OZONE PARK NY
11420-1034
US

IV. Provider business mailing address

10819 ROCKAWAY BLVD
SOUTH OZONE PARK NY
11420-1034
US

V. Phone/Fax

Practice location:
  • Phone: 718-845-2620
  • Fax: 718-845-9380
Mailing address:
  • Phone: 718-845-2620
  • Fax: 718-845-9380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081219-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: