Individual
DR. RICHARD RUSSELL PHILLIPS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2307 MASSACHUSETTS AVE, CAMBRIDGE, MA 02140-1227
(617) 864-0103
Mailing address
2307 MASSACHUSETTS AVE, CAMBRIDGE, MA 02140-1227
(617) 864-0103
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
4828
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W04591
BLUE CROSS BLUE SHIELD
MA
Enumeration date
08/23/2007
Last updated
08/23/2007
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