1053542910 NPI number — CARLANN M. WELCH, PSY.D., LLC

Table of content: (NPI 1053542910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053542910 NPI number — CARLANN M. WELCH, PSY.D., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARLANN M. WELCH, PSY.D., LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053542910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
57 EXCHANGE ST
Provider Second Line Business Mailing Address:
SUITE 403
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04101-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-775-0382
Provider Business Mailing Address Fax Number:
207-775-4454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57 EXCHANGE ST
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04101-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-775-0382
Provider Business Practice Location Address Fax Number:
207-775-4454
Provider Enumeration Date:
07/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WELCH
Authorized Official First Name:
CARLANN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
207-775-0382

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PS847 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 153990000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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