Provider Demographics
NPI:1215232442
Name:PHILLIPPI, CAREN LINDA (LMHC)
Entity type:Individual
Prefix:
First Name:CAREN
Middle Name:LINDA
Last Name:PHILLIPPI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9478
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34206-9478
Mailing Address - Country:US
Mailing Address - Phone:941-782-4299
Mailing Address - Fax:941-782-4301
Practice Address - Street 1:379 6TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8820
Practice Address - Country:US
Practice Address - Phone:941-782-4100
Practice Address - Fax:941-782-4101
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10605101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health