Provider Demographics
NPI:1811059603
Name:PHELPS, MOLLY EILEEN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:EILEEN
Last Name:PHELPS
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 1:3096 KINGSBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1628
Mailing Address - Country:US
Mailing Address - Phone:315-635-2490
Mailing Address - Fax:
Practice Address - Street 1:5980 S STREET RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-5678
Practice Address - Country:US
Practice Address - Phone:315-253-0361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker