Provider Demographics
NPI:1649150996
Name:PHILLIPS, KENYON CHRISTIAN (LMSW)
Entity type:Individual
Prefix:MR
First Name:KENYON
Middle Name:CHRISTIAN
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 RIDGE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1642
Mailing Address - Country:US
Mailing Address - Phone:646-327-7171
Mailing Address - Fax:
Practice Address - Street 1:9 RIDGE VALLEY RD
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1642
Practice Address - Country:US
Practice Address - Phone:646-327-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-06
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11639104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker