Provider Demographics
NPI:1043473275
Name:WELLES, DONNA M (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:WELLES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 PLAIN ST
Mailing Address - Street 2:UNIT I
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2118
Mailing Address - Country:US
Mailing Address - Phone:781-834-7433
Mailing Address - Fax:781-834-7458
Practice Address - Street 1:769 PLAIN ST
Practice Address - Street 2:UNIT I
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2118
Practice Address - Country:US
Practice Address - Phone:781-834-7433
Practice Address - Fax:781-834-7458
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20249611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303767Medicaid