Provider Demographics
NPI:1841537685
Name:WELCH, JAMAN P (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMAN
Middle Name:P
Last Name:WELCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 N MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1446
Mailing Address - Country:US
Mailing Address - Phone:585-919-0014
Mailing Address - Fax:585-393-0014
Practice Address - Street 1:42 N MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1446
Practice Address - Country:US
Practice Address - Phone:585-919-0014
Practice Address - Fax:585-393-0014
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019942103T00000X, 103TB0200X, 103TH0004X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth