Provider Demographics
NPI:1588731830
Name:PHILIP, BABU (LCSW)
Entity type:Individual
Prefix:MR
First Name:BABU
Middle Name:
Last Name:PHILIP
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 SAINT JOHNS PL
Mailing Address - Street 2:3J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-5650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UPPER MANHATTAN MENTAL HEALTH CENTER, 1727 AMSTRDM AVE
Practice Address - Street 2:CHEMICAL DEPENDENCE SERVICES, 3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031
Practice Address - Country:US
Practice Address - Phone:212-694-9200
Practice Address - Fax:212-694-4619
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR050903-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7Q591Medicare ID - Type Unspecified