Provider Demographics
NPI:1386091692
Name:WELLS, ALESHA (BA)
Entity type:Individual
Prefix:
First Name:ALESHA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 PUTNAM ROAD
Mailing Address - Street 2:
Mailing Address - City:WAUREGAN
Mailing Address - State:CT
Mailing Address - Zip Code:06387-0378
Mailing Address - Country:US
Mailing Address - Phone:860-564-6100
Mailing Address - Fax:860-564-6110
Practice Address - Street 1:303 PUTNAM ROAD
Practice Address - Street 2:
Practice Address - City:WAUREGAN
Practice Address - State:CT
Practice Address - Zip Code:06387-0378
Practice Address - Country:US
Practice Address - Phone:860-564-6100
Practice Address - Fax:860-564-6110
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040564Medicaid