Provider Demographics
NPI:1699298091
Name:WELCH, TRACEY ELVIRA (LMHC)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:ELVIRA
Last Name:WELCH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 N CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-1407
Mailing Address - Country:US
Mailing Address - Phone:585-546-7220
Mailing Address - Fax:585-546-2607
Practice Address - Street 1:55 TROUP STREET
Practice Address - Street 2:CATHOLIC FAMILY CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-2053
Practice Address - Country:US
Practice Address - Phone:585-546-7220
Practice Address - Fax:585-546-2606
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005717-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005717-1OtherNYS OFFICE OF PROFESSIONS