Healthcare Provider Details

I. General information

NPI: 1619590726
Provider Name (Legal Business Name): AMANDA S. PHILLIPS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W RIVER ST STE 11B
PROVIDENCE RI
02904-2609
US

IV. Provider business mailing address

146 W RIVER ST STE 11B
PROVIDENCE RI
02904-2609
US

V. Phone/Fax

Practice location:
  • Phone: 401-606-0606
  • Fax:
Mailing address:
  • Phone: 401-606-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPS02078
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS02078
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: