Provider Demographics
NPI:1780860817
Name:WELCH, KATHRYN PHILOMENA
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:PHILOMENA
Last Name:WELCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:PHILOMENA
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:171 AVERILL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-1317
Mailing Address - Country:US
Mailing Address - Phone:716-969-3841
Mailing Address - Fax:
Practice Address - Street 1:171 AVERILL AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1317
Practice Address - Country:US
Practice Address - Phone:716-969-3841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW824291041C0700X
MELC146171041C0700X, 1041C0700X
NY0915661041C0700X, 1041C0700X
ME#LC146171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical