Provider Demographics
NPI:1134147366
Name:PHELPS, DEANNA LOUISE (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:LOUISE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3523 BAY DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-4402
Mailing Address - Country:US
Mailing Address - Phone:410-335-2266
Mailing Address - Fax:
Practice Address - Street 1:4623 FALLS ROAD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209
Practice Address - Country:US
Practice Address - Phone:410-366-1980
Practice Address - Fax:410-366-8530
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD049311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD226396OtherKAISER
MD890943-01OtherCAREFIRST BCBS
MDT541-0078OtherCAREFIRST BCBS
MDPVPB1348746OtherAPS HEALTHCARE
MH7186396OtherAETNA BEHAVIORAL HEALTH
MD179967OtherCOMPSYCH