Provider Demographics
NPI:1861436784
Name:PHILLIPS, ELAINE (LPC)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MILL PLAIN RD
Mailing Address - Street 2:STE 366
Mailing Address - City:DAUBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-5178
Mailing Address - Country:US
Mailing Address - Phone:203-791-3828
Mailing Address - Fax:203-791-3885
Practice Address - Street 1:100 MILL PLAIN RD
Practice Address - Street 2:STE 366
Practice Address - City:DAUBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-5178
Practice Address - Country:US
Practice Address - Phone:203-791-3828
Practice Address - Fax:203-791-3885
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000647101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
P2134362OtherOXFORD HEALTH PLANS
PHILELANOtherCORP HEALTH INC
240000647CT01OtherANTHEM BLUE CROSS BLUE SH
5887739OtherAETNA
PIN309006OtherMANAGED HEALTH NETWORK
IP556121OtherMAGELLAN BEHAVIORAL HEALT