Provider Demographics
NPI:1659843894
Name:PHELAN, MUIREANN (LMSW)
Entity Type:Individual
Prefix:
First Name:MUIREANN
Middle Name:
Last Name:PHELAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3424
Mailing Address - Country:US
Mailing Address - Phone:516-870-2862
Mailing Address - Fax:
Practice Address - Street 1:PARK AND DOWNING AVENUES
Practice Address - Street 2:
Practice Address - City:SEA CLIFF
Practice Address - State:NY
Practice Address - Zip Code:11579
Practice Address - Country:US
Practice Address - Phone:516-629-8128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102229-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker