Provider Demographics
NPI:1285778548
Name:PHILLIPS MCENANY, GEOFFRY W (PHD, APRN, BC)
Entity type:Individual
Prefix:DR
First Name:GEOFFRY
Middle Name:W
Last Name:PHILLIPS MCENANY
Suffix:
Gender:M
Credentials:PHD, APRN, BC
Other - Prefix:DR
Other - First Name:GEOFFRY
Other - Middle Name:W
Other - Last Name:MCENANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, APRN, BC
Mailing Address - Street 1:48 SPRUCE AVE.
Mailing Address - Street 2:
Mailing Address - City:PEAKS ISLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04108
Mailing Address - Country:US
Mailing Address - Phone:617-696-7925
Mailing Address - Fax:617-322-1084
Practice Address - Street 1:48 SPRUCE AVE.
Practice Address - Street 2:
Practice Address - City:PEAKS ISLAND
Practice Address - State:ME
Practice Address - Zip Code:04108
Practice Address - Country:US
Practice Address - Phone:857-290-8197
Practice Address - Fax:866-323-2249
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239814163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA269301000OtherMAGELLAN HEALTH SERVICES
MA008805OtherVALUE OPTIONS
MA346824OtherTUFTS HEALTH PLAN
MA3737024OtherAETNA
MA9631-01OtherHARVARD PILGRIM HEALTH CA
MANS0544OtherMEDICARE PART B
MAPN0702OtherBLUE CROSS BLUE SHIELD