Provider Demographics
NPI:1437871381
Name:PHELAN, PATRICIA M (MSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:PHELAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15552 TITUS CT APT 2106
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-4595
Mailing Address - Country:US
Mailing Address - Phone:612-310-3594
Mailing Address - Fax:
Practice Address - Street 1:5814 S 142ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2853
Practice Address - Country:US
Practice Address - Phone:402-965-1017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical