Healthcare Provider Details

I. General information

NPI: 1134147366
Provider Name (Legal Business Name): DEANNA LOUISE PHELPS LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4623 FALLS ROAD
BALTIMORE MD
21209
US

IV. Provider business mailing address

3523 BAY DR
MIDDLE RIVER MD
21220-4402
US

V. Phone/Fax

Practice location:
  • Phone: 410-366-1980
  • Fax: 410-366-8530
Mailing address:
  • Phone: 410-335-2266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number04931
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: