Provider Demographics
NPI:1528147956
Name:PHILLIPS, MIRIAM ANDERSON (MS)
Entity type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:ANDERSON
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 EAST KING STREET
Mailing Address - Street 2:
Mailing Address - City:ABBOTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17301-9459
Mailing Address - Country:US
Mailing Address - Phone:717-476-3586
Mailing Address - Fax:
Practice Address - Street 1:129 CHARLES ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1807
Practice Address - Country:US
Practice Address - Phone:717-633-1227
Practice Address - Fax:717-633-5250
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30564OtherSOUTH CENTRAL PREFERRED