Provider Demographics
NPI:1720145048
Name:SOBCZAK-WELSH, AUGUSTA ANNE (RN, CRC, LMHC)
Entity Type:Individual
Prefix:MS
First Name:AUGUSTA
Middle Name:ANNE
Last Name:SOBCZAK-WELSH
Suffix:
Gender:F
Credentials:RN, CRC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 INDIAN FALLS RD
Mailing Address - Street 2:
Mailing Address - City:CORFU
Mailing Address - State:NY
Mailing Address - Zip Code:14036-9734
Mailing Address - Country:US
Mailing Address - Phone:585-762-8347
Mailing Address - Fax:
Practice Address - Street 1:GCMHS 5130 EAST MAIN ST RD
Practice Address - Street 2:SUITE #2
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3496
Practice Address - Country:US
Practice Address - Phone:585-344-1421
Practice Address - Fax:585-344-8554
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002368101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health