Individual provider Active NPI

Michael Stuart Phillips, PH.D.

  • Clinical Psychologist
  • Nashua, NH
National Provider Identifier
1366458341
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
807 Issued in NH
Practice address
39 Simon St
Unit 5
Nashua, NH 03060-3046
Phone
(603) 889-8648
Fax
(603) 882-9666
NPI assigned
Jul 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 807 NH Primary

Addresses

Primary practice location

39 Simon St
Unit 5
Nashua, NH 03060-3046

Mailing address

39 Simon St
Unit 5
Nashua, NH 03060-3046
Phone (603) 889-8648

Other identifiers 1

IdentifierTypeStateIssuer
30420912MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060511000101 NH Practitioner - Clinical Psychologist 4789636184 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1995
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Lamora Psychological Associates, P.a.Group PAC ID 3072565472, 11 clinicians

Practice addresses (Care Compare)

10 Commerce Park N
Suite 1a
Bedford, NH 03110-6951
Phone (603) 889-8648

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
807NHMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Lamora Psychological Associates, P.a. Clinical CurrentSince Jul 15, 2002 Accepting new patients

Locations

10 Commerce Park North
Ste 1A
Bedford, NH 03110
Phone (603) 606-1233

39 Simon St
Ste 5
Nashua, NH 03060
Phone (603) 598-5400

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1366458341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 SIMON ST",
            "address_2": "UNIT 5",
            "city": "NASHUA",
            "state": "NH",
            "postal_code": "030603046",
            "telephone_number": "603-889-8648",
            "fax_number": "603-882-9666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 SIMON ST",
            "address_2": "UNIT 5",
            "city": "NASHUA",
            "state": "NH",
            "postal_code": "030603046",
            "telephone_number": "603-889-8648",
            "fax_number": "603-882-9666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "MICHAEL",
        "middle_name": "STUART",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NH",
            "license": "807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30420912",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashua, NH

Sources for this page

Verify at the official NPI Registry.