Provider Demographics
NPI:1588311385
Name:JESSICA WELCH LLC
Entity type:Organization
Organization Name:JESSICA WELCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-333-0330
Mailing Address - Street 1:151 OLD PORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:NORTH WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04061-4901
Mailing Address - Country:US
Mailing Address - Phone:207-333-0330
Mailing Address - Fax:
Practice Address - Street 1:12 ELM ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1506
Practice Address - Country:US
Practice Address - Phone:207-370-1282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health