MEDICARE: LINDSEY PHILLIPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW-22680	AZ
2	1041C0700X	Clinical Social Worker	LCSW-5311	HI

General Provider Information

NPI Number	:	1629865761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY PHILLIPS

Provider Business Mailing Address
First Line	:	91-1798 LAUO ST
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-4836
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-1798 LAUO ST
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-4836
Country	:	US
Telephone Number	:	814-746-7584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2025
Last Update Date	:	04/22/2025

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Directions to “ LINDSEY PHILLIPS ” Practice Location

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