Provider Demographics
NPI:1063554947
Name:WELCH, CARLANN M (PSYD)
Entity type:Individual
Prefix:DR
First Name:CARLANN
Middle Name:M
Last Name:WELCH
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 EXCHANGE ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-5000
Mailing Address - Country:US
Mailing Address - Phone:207-775-0382
Mailing Address - Fax:207-775-4454
Practice Address - Street 1:57 EXCHANGE ST
Practice Address - Street 2:SUITE 403
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-5000
Practice Address - Country:US
Practice Address - Phone:207-775-0382
Practice Address - Fax:207-775-4454
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS847103T00000X
MECNP191213364SP0808X, 364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME153990099Medicaid
ME048599Medicare UPIN