Provider Demographics
NPI:1811878283
Name:PHILLIPS, ARLEEN LOUISE (MS EDUCATION)
Entity type:Individual
Prefix:
First Name:ARLEEN
Middle Name:LOUISE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6643 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:NY
Mailing Address - Zip Code:12993-2005
Mailing Address - Country:US
Mailing Address - Phone:518-962-4303
Mailing Address - Fax:
Practice Address - Street 1:10 ST PATRICK PL
Practice Address - Street 2:
Practice Address - City:PORT HENRY
Practice Address - State:NY
Practice Address - Zip Code:12974-1200
Practice Address - Country:US
Practice Address - Phone:518-546-3381
Practice Address - Fax:518-546-7138
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102252071174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty