Provider Demographics
NPI:1740376227
Name:WELLS, ANNE MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:MARIE
Last Name:WELLS
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 1:2740 OAK RIDGE CT STE 304
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9371
Mailing Address - Country:US
Mailing Address - Phone:239-368-3708
Mailing Address - Fax:239-368-3708
Practice Address - Street 1:2740 OAK RIDGE CT STE 304
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9371
Practice Address - Country:US
Practice Address - Phone:239-368-3708
Practice Address - Fax:239-368-3708
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5593103T00000X, 103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54174OtherBLUE CROSS BLUE SHIELD
FL54174Medicare ID - Type Unspecified