Provider Demographics
NPI:1255219937
Name:PHELAN, MAEVE ELISABETH
Entity type:Individual
Prefix:
First Name:MAEVE
Middle Name:ELISABETH
Last Name:PHELAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 GRONWALL LN
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5242
Mailing Address - Country:US
Mailing Address - Phone:650-450-3945
Mailing Address - Fax:
Practice Address - Street 1:1779 WOODSIDE RD STE 200
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3438
Practice Address - Country:US
Practice Address - Phone:650-424-0852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA156818106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist