Healthcare Provider Details

I. General information

NPI: 1255929865
Provider Name (Legal Business Name): MATTHEW CHARLES PHELPS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E NORTH AVE RM 211
BALTIMORE MD
21202-5984
US

IV. Provider business mailing address

7 N CALVERT ST APT 602
BALTIMORE MD
21202-2250
US

V. Phone/Fax

Practice location:
  • Phone: 443-984-2000
  • Fax:
Mailing address:
  • Phone: 443-852-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number24850
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number24850
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: