Provider Demographics
NPI:1477992626
Name:WELCHONS, LEAH WILDENGER (PHD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:WILDENGER
Last Name:WELCHONS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 ARMORY DR
Mailing Address - Street 2:BUILDING C
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5405
Mailing Address - Country:US
Mailing Address - Phone:315-797-6241
Mailing Address - Fax:315-749-7054
Practice Address - Street 1:1601 ARMORY DR
Practice Address - Street 2:BUILDING C
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5405
Practice Address - Country:US
Practice Address - Phone:315-797-6241
Practice Address - Fax:315-749-7054
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019777103TC2200X
MA9716103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent