MEDICARE: MARY ELIZABETH T. WELLENCE LMHC

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	101YM0800X	Mental Health Counselor	006799	NY

General Provider Information

NPI Number	:	1962850339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH T. WELLENCE LMHC

Provider Business Mailing Address
First Line	:	3829 FOREST PARK WAY STE 100
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-3762
Country	:	US
Telephone Number	:	716-812-8370
Fax Number	:	716-304-1430

Provider Business Practice Location Address
First Line	:	3829 FOREST PARK WAY STE 100
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-3762
Country	:	US
Telephone Number	:	716-812-8370
Fax Number	:	716-304-1430

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

Provider Enumeration Date	:	05/26/2016
Last Update Date	:	03/25/2025

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