Provider Demographics
NPI:1316410020
Name:PHELPS, MARGARET (LICSW)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:PHELPS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-6627
Mailing Address - Country:US
Mailing Address - Phone:781-710-2511
Mailing Address - Fax:
Practice Address - Street 1:20 PARK PLZ STE 1420
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-4311
Practice Address - Country:US
Practice Address - Phone:617-236-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA114529104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker