Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 288 | RI |
N | 103T00000X | Psychologist | 288 | RI |
N | 102L00000X | Psychologist | 3090 | MA |
N | 103T00000X | Psychologist | 3090 | MA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 288 | RI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3090 | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 288 | RI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 3090 | MA |
N | 103TH0100X | Health Service | 288 | MA |
N | 103TH0100X | Health Service | 3090 | MA |
N | 103TS0200X | School Psychologist | 288 | RI |
N | 103TS0200X | School Psychologist | 3090 | MA |
NPI | 1235262882 |
---|---|
Provider Name | Dr. Mary M. Wellman |
First Address | Uxbridge, MA 01569-1174 |
Second Address | Uxbridge, MA 01569-1174 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0512192 | (05) | MA |
9329-9 | BLUE SHIELD PSYCHOLOGIST (01) | RI |
WEWO3222 | BLUE SHIELD PSYCHOLOGIST (01) | MA |