Provider Demographics
NPI:1750419800
Name:WELLING, KAREN ANN (MSW)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ANN
Last Name:WELLING
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2511
Mailing Address - Country:US
Mailing Address - Phone:617-623-3703
Mailing Address - Fax:
Practice Address - Street 1:403 HIGHLAND AVE STE 202
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2530
Practice Address - Country:US
Practice Address - Phone:617-623-3703
Practice Address - Fax:617-666-5832
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1058091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO5477Medicare ID - Type Unspecified