Provider Demographics
NPI:1861145385
Name:WELLS, KATHERINE (MA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 DRAKE DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-6108
Mailing Address - Country:US
Mailing Address - Phone:845-731-9727
Mailing Address - Fax:
Practice Address - Street 1:306 DRAKE DR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-6108
Practice Address - Country:US
Practice Address - Phone:845-731-9727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst