Provider Demographics
NPI:1346653391
Name:WELCH, MICHELE ANNE (MALPMFT)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ANNE
Last Name:WELCH
Suffix:
Gender:F
Credentials:MALPMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 OAK ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2938
Mailing Address - Country:US
Mailing Address - Phone:607-621-2740
Mailing Address - Fax:
Practice Address - Street 1:405 OAK ST FL 2
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2938
Practice Address - Country:US
Practice Address - Phone:607-621-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP92933106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist