Provider Demographics
NPI:1649649765
Name:WELCH, KYRA
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OYSTER BAY RD APT D
Mailing Address - Street 2:
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201-2834
Mailing Address - Country:US
Mailing Address - Phone:609-816-1779
Mailing Address - Fax:
Practice Address - Street 1:1 OYSTER BAY ROAD APT. D
Practice Address - Street 2:
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201
Practice Address - Country:US
Practice Address - Phone:609-816-1779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health