Provider Demographics
NPI:1518218445
Name:PHELAN, AMANDA G (LCSW-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:G
Last Name:PHELAN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:C
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5229 NEW DESIGN RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7103
Mailing Address - Country:US
Mailing Address - Phone:240-415-8620
Mailing Address - Fax:
Practice Address - Street 1:5229 NEW DESIGN RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7103
Practice Address - Country:US
Practice Address - Phone:240-415-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD154711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical