Healthcare Provider Details

I. General information

NPI: 1467640821
Provider Name (Legal Business Name): NANCY ANNE WELSH M. A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1096 N CHURCH ST
HAZLETON PA
18202-1410
US

IV. Provider business mailing address

1096 N CHURCH ST
HAZLETON PA
18202-1410
US

V. Phone/Fax

Practice location:
  • Phone: 570-455-6119
  • Fax:
Mailing address:
  • Phone: 570-455-6119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS005919/L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: