Provider Demographics
NPI:1659954964
Name:PHELAN, DANIELLA M (MA, EDM, NCSP)
Entity Type:Individual
Prefix:MS
First Name:DANIELLA
Middle Name:M
Last Name:PHELAN
Suffix:
Gender:F
Credentials:MA, EDM, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 HARBOR DRIVE
Mailing Address - Street 2:#410
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902
Mailing Address - Country:US
Mailing Address - Phone:860-966-6258
Mailing Address - Fax:
Practice Address - Street 1:17 BERKLEY DRIVE
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573
Practice Address - Country:US
Practice Address - Phone:914-937-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2576886103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool