Provider Demographics
NPI:1902230782
Name:WELTON, MARIA LUIZA JULIET BARBOSA (LICSW)
Entity Type:Individual
Prefix:
First Name:MARIA LUIZA JULIET
Middle Name:BARBOSA
Last Name:WELTON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE CONSTITUTION WHARF
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-4316
Mailing Address - Country:US
Mailing Address - Phone:857-408-3797
Mailing Address - Fax:
Practice Address - Street 1:21 JUMEL PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4316
Practice Address - Country:US
Practice Address - Phone:212-927-6675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1205711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical