Active NPI
Waltor M Phillips, PH D
- Clinical Psychologist
- Middlebury, CT
National Provider Identifier
1013081819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 621
- Practice address
- 415 Middlebury Road
Middlebury, CT 06762 - Phone
- (203) 758-8333
- Fax
- (203) 758-8333
- NPI assigned
- Nov 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 621 | CT | Primary |
Addresses
Primary practice location
415 Middlebury Road
Middlebury, CT 06762
Mailing address
415 Middlebury Road
Middlebury, CT 06762
Phone (203) 758-8333
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000621 | CT | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013081819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 MIDDLEBURY ROAD",
"city": "MIDDLEBURY",
"state": "CT",
"postal_code": "06762",
"telephone_number": "203-758-8333",
"fax_number": "203-758-8333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 MIDDLEBURY ROAD",
"city": "MIDDLEBURY",
"state": "CT",
"postal_code": "06762",
"telephone_number": "203-758-8333",
"fax_number": "203-758-8333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "WALTOR",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "PH D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CT",
"license": "621",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middlebury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.