Provider Demographics
NPI:1467941427
Name:WELLMAN, ROBERT J (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:WELLMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 W HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:UXBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01569-1174
Mailing Address - Country:US
Mailing Address - Phone:508-278-6600
Mailing Address - Fax:
Practice Address - Street 1:216 W HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:UXBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01569-1174
Practice Address - Country:US
Practice Address - Phone:508-278-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-05
Last Update Date:2018-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA191-PY-PR103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist