MEDICARE: BRIAN WELCH PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS017885	PA
2	103TC0700X	Clinical Psychologist	019683	NY

General Provider Information

NPI Number	:	1669623252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN WELCH PSY.D.

Provider Business Mailing Address
First Line	:	1315 WALNUT ST STE 1700
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4717
Country	:	US
Telephone Number	:	267-702-4747
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 WALNUT ST STE 1700
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4717
Country	:	US
Telephone Number	:	267-702-4747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2008
Last Update Date	:	06/30/2022

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