Provider Demographics
NPI:1770825705
Name:WELCH, JOHN D (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:WELCH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 BROADWAY
Mailing Address - Street 2:STE. 1124
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1133 BROADWAY STE 607
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8079
Practice Address - Country:US
Practice Address - Phone:917-656-6923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-16
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078475-11041C0700X
NY0784751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical