Provider Demographics
NPI:1447757372
Name:PHELAN, JAMES PATRICK (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:PATRICK
Last Name:PHELAN
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3037
Mailing Address - Country:US
Mailing Address - Phone:585-448-0936
Mailing Address - Fax:585-448-0973
Practice Address - Street 1:2450 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-3037
Practice Address - Country:US
Practice Address - Phone:585-448-0936
Practice Address - Fax:585-448-0973
Is Sole Proprietor?:No
Enumeration Date:2018-04-08
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0341381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical