Provider Demographics
NPI:1104053719
Name:PHILLIPS, BETTY A (LCSW)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:A
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 S MAIN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-4654
Mailing Address - Country:US
Mailing Address - Phone:609-693-4343
Mailing Address - Fax:609-693-4345
Practice Address - Street 1:424 S MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-4654
Practice Address - Country:US
Practice Address - Phone:609-693-4343
Practice Address - Fax:609-693-4345
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC049941001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical