Provider Demographics
NPI:1467623215
Name:PHELAN, ELIZABETH M (MS,LPC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:M
Last Name:PHELAN
Suffix:
Gender:F
Credentials:MS,LPC
Other - Prefix:MS
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:PHELAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 1068
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06057-0980
Mailing Address - Country:US
Mailing Address - Phone:860-738-8362
Mailing Address - Fax:860-266-4687
Practice Address - Street 1:96 WICKETT ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06057
Practice Address - Country:US
Practice Address - Phone:860-738-8362
Practice Address - Fax:860-266-4687
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001643101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor