Healthcare Provider Details

I. General information

NPI: 1962850339
Provider Name (Legal Business Name): MARY ELIZABETH T. WELLENCE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 BROADWAY STE N
ALBANY NY
12207-2922
US

IV. Provider business mailing address

418 BROADWAY STE N
ALBANY NY
12207-2922
US

V. Phone/Fax

Practice location:
  • Phone: 716-812-8370
  • Fax: 716-304-1430
Mailing address:
  • Phone: 716-812-8370
  • Fax: 716-304-1430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number006799
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: