Provider Demographics
NPI:1154383057
Name:PHILLIPS, ARIEL INGRID AINO (EDD)
Entity type:Individual
Prefix:DR
First Name:ARIEL
Middle Name:INGRID AINO
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5004
Mailing Address - Country:US
Mailing Address - Phone:617-495-2581
Mailing Address - Fax:617-495-7680
Practice Address - Street 1:5 LINDEN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5004
Practice Address - Country:US
Practice Address - Phone:617-495-2581
Practice Address - Fax:617-495-7680
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6942103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling