Provider Demographics
NPI:1629700539
Name:WELLSVILLE WELLNESS PSYCHOLOGICAL
Entity Type:Organization
Organization Name:WELLSVILLE WELLNESS PSYCHOLOGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:585-466-4711
Mailing Address - Street 1:118 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-1251
Mailing Address - Country:US
Mailing Address - Phone:585-340-7011
Mailing Address - Fax:
Practice Address - Street 1:118 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1251
Practice Address - Country:US
Practice Address - Phone:585-340-7011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty