Provider Demographics
NPI:1285788034
Name:HANCOCK, PHYLLIS C (LCSW)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:C
Last Name:HANCOCK
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 1:39 PHELPS AVE
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-2524
Mailing Address - Country:US
Mailing Address - Phone:201-568-1646
Mailing Address - Fax:
Practice Address - Street 1:39 PHELPS AVE
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-2524
Practice Address - Country:US
Practice Address - Phone:201-568-1646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045626001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ090550B59Medicare Oscar/Certification