Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 621 | CT |
Y | 103TC0700X | Clinical Psychologist | 621 | CT |
NPI | 1013081819 |
---|---|
Provider Name | Dr. Waltor M Phillips |
First Address | Middlebury, CT 06762 |
Second Address | Middlebury, CT 06762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |