Provider Demographics
NPI:1225056559
Name:PHELPS, PATRICIA A (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:PHELPS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:375 BAY RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-3438
Mailing Address - Country:US
Mailing Address - Phone:207-752-3756
Mailing Address - Fax:
Practice Address - Street 1:16 FRANKLIN ST, UNIT D
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833
Practice Address - Country:US
Practice Address - Phone:207-752-3756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30422429Medicaid
NH14Y001232NH02OtherANTHEM BLUE CROSS
NHRE6325Medicare ID - Type Unspecified