Provider Demographics
NPI:1427299809
Name:DEPHILIPPIS, DOMINICK (PHD)
Entity type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:
Last Name:DEPHILIPPIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1152
Mailing Address - Country:US
Mailing Address - Phone:609-704-1280
Mailing Address - Fax:609-704-2866
Practice Address - Street 1:140 CYPRESS CT
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1152
Practice Address - Country:US
Practice Address - Phone:609-704-1280
Practice Address - Fax:609-704-2866
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015026103TC0700X, 103T00000X
CT001952103T00000X, 103TA0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)