Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | SS 583 | FL |
NPI | 1093854770 |
---|---|
Provider Name | Mr. Richard Phillips |
First Address | Hollywood, FL 33021-3118 |
Second Address | Plantation, FL 33317-4054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 08/07/2007 |