Individual
DR. FORMAN PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
9 W SAND LAKE RD, WYNANTSKILL, NY 12198-7954
(518) 283-1974
(518) 283-2018
Mailing address
9 W SAND LAKE RD, WYNANTSKILL, NY 12198-7954
(518) 283-1974
(518) 283-2018
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
4809
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01653194
—
NY
Enumeration date
01/10/2007
Last updated
07/08/2007
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