Healthcare Provider Details

I. General information

NPI: 1063554947
Provider Name (Legal Business Name): CARLANN M WELCH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 EXCHANGE ST SUITE 403
PORTLAND ME
04101-5000
US

IV. Provider business mailing address

57 EXCHANGE ST SUITE 403
PORTLAND ME
04101-5000
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-0382
  • Fax: 207-775-4454
Mailing address:
  • Phone: 207-775-0382
  • Fax: 207-775-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License NumberCNP191213
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberCNP191213
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS847
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: