Provider Demographics
NPI:1386745123
Name:LOWRY, PHILLIP (LMHC)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:LOWRY
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 LEAH ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-3906
Mailing Address - Country:US
Mailing Address - Phone:401-331-4585
Mailing Address - Fax:
Practice Address - Street 1:807 BROAD ST
Practice Address - Street 2:SUITE 411 BOX #2
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1676
Practice Address - Country:US
Practice Address - Phone:401-941-0756
Practice Address - Fax:401-941-0757
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00137101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000030460OtherBLUE CROSS
RI18902OtherBLUE CHIP
RI6262427OtherUNITED HEALTH
RIPL35114Medicaid