Provider Demographics
NPI:1174738819
Name:PHILLIPS, DEBORAH ANN (MS, LDN, CHES)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS, LDN, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1537
Mailing Address - Country:US
Mailing Address - Phone:413-528-8967
Mailing Address - Fax:
Practice Address - Street 1:168 MAIN ST
Practice Address - Street 2:PEDIATRIC DEVELOPMENT CENTER
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1618
Practice Address - Country:US
Practice Address - Phone:413-637-8921
Practice Address - Fax:413-644-0039
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1610133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist