Provider Demographics
NPI:1215973284
Name:WELCH, MICHELE (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 MASS AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02173
Mailing Address - Country:US
Mailing Address - Phone:781-863-2236
Mailing Address - Fax:
Practice Address - Street 1:5 MIDDLESEX AVE
Practice Address - Street 2:SUITE 11 WILMINGTON FAMILY COUNSELING SERVICE INC
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887
Practice Address - Country:US
Practice Address - Phone:978-658-9889
Practice Address - Fax:978-658-5695
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4633103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04458Medicare ID - Type Unspecified