Provider Demographics
NPI:1760759005
Name:WELCH, COLLEEN (MSCJ-MH)
Entity Type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:MSCJ-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 MAPLE ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3200
Mailing Address - Country:US
Mailing Address - Phone:508-808-4944
Mailing Address - Fax:
Practice Address - Street 1:340 MAPLE ST
Practice Address - Street 2:SUITE 401
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3200
Practice Address - Country:US
Practice Address - Phone:508-808-4944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health