Individual
MS. MALICAH CHANTAL PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7000 AUSTIN ST STE 200, FOREST HILLS, NY 11375-4739
(917) 371-6402
Mailing address
3930 59TH ST APT B11, WOODSIDE, NY 11377-3405
(917) 371-6402
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
NY
Other
Enumeration date
12/30/2016
Last updated
12/30/2016
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