Provider Demographics
NPI:1730259664
Name:PHAKOS, VIRGINIA A (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:A
Last Name:PHAKOS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4716
Mailing Address - Country:US
Mailing Address - Phone:617-547-7271
Mailing Address - Fax:617-666-5832
Practice Address - Street 1:288 PEARL ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4716
Practice Address - Country:US
Practice Address - Phone:617-547-7271
Practice Address - Fax:617-666-5832
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10162951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO4923OtherBLUE CROSS BLUE SHIELD
MA190378OtherMAGELLAN
MAPO4923OtherBLUE CROSS BLUE SHIELD