Provider Demographics
NPI:1700664158
Name:WELCH, JUSTINA
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:TRANQUILITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07879-0129
Mailing Address - Country:US
Mailing Address - Phone:862-284-7187
Mailing Address - Fax:
Practice Address - Street 1:33 KENNEDY RD
Practice Address - Street 2:STE 33A
Practice Address - City:ANDOVER
Practice Address - State:NJ
Practice Address - Zip Code:07821
Practice Address - Country:US
Practice Address - Phone:862-284-7187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00667500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional