Provider Demographics
NPI:1992851042
Name:WELCH, MARY JANE (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:WELCH
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 LUCKEY ROAD
Mailing Address - Street 2:P.O. BOX 27
Mailing Address - City:LUCKEY
Mailing Address - State:OH
Mailing Address - Zip Code:43443-0027
Mailing Address - Country:US
Mailing Address - Phone:419-833-5584
Mailing Address - Fax:
Practice Address - Street 1:3333 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2426
Practice Address - Country:US
Practice Address - Phone:419-259-2000
Practice Address - Fax:419-259-3850
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00094081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical