Provider Demographics
NPI:1063566677
Name:D AMOUR, PHILLIP C (MA LMHC)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:C
Last Name:D AMOUR
Suffix:
Gender:M
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-6276
Mailing Address - Country:US
Mailing Address - Phone:781-248-8355
Mailing Address - Fax:508-993-6353
Practice Address - Street 1:32 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6276
Practice Address - Country:US
Practice Address - Phone:781-248-8355
Practice Address - Fax:508-993-6353
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health