Provider Demographics
NPI:1154587236
Name:PHILLIPS, MARTHA C (MACCC-A)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:C
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MACCC-A
Other - Prefix:MISS
Other - First Name:MARTHA
Other - Middle Name:C
Other - Last Name:ASSAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCCA
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10535-0215
Mailing Address - Country:US
Mailing Address - Phone:845-227-5033
Mailing Address - Fax:845-227-3503
Practice Address - Street 1:3630 HILL BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535-1502
Practice Address - Country:US
Practice Address - Phone:914-245-7700
Practice Address - Fax:914-245-7836
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000730-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist