Provider Demographics
NPI:1366772626
Name:PHILLIPS, DARELL LAMONT (LCSW,)
Entity type:Individual
Prefix:
First Name:DARELL
Middle Name:LAMONT
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LCSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 MURRAY AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1655
Mailing Address - Country:US
Mailing Address - Phone:412-327-2189
Mailing Address - Fax:
Practice Address - Street 1:1824 MURRAY AVE
Practice Address - Street 2:SUITE, 304
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1655
Practice Address - Country:US
Practice Address - Phone:412-327-2189
Practice Address - Fax:412-344-8076
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-10
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW127557104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker