DR. MIRYAM WELBOURNE (NPI# 1811363062) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811363062 |
| Entity Type | Individual |
| Full Name | DR. MIRYAM WELBOURNE |
| Other Name | DR. MIRYAM WELBOURNE |
| Credential | PSY.D. |
| Practice Address |
363 Main St Middletown CT 06457-3359 |
| Mailing Address |
104 Strickland Rd Middlefield CT 06455-1225 |
| Practice Telephone | 2038361794 |
| Practice Fax Number | 8886003738 |
| Mailing Telephone | 2038361794 |
| Mailing Fax Number | 8886003738 |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2018-12-12 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | 3491 | CT | Behavioral Health & Social Service Providers |
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 008061424 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 261 Bradley St, New Haven, CT 065101110 | 2038361794 | 8886003738 |
| 363 Main St, Middletown, CT 064573359 | 2038361794 | 8886003738 |
| Street Address |
363 MAIN ST |
| City | MIDDLETOWN |
| State | CT |
| Zip Code | 06457-3359 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518494202 | Single Step, LLC | Marriage & Family Therapist | 363 Main St, Middletown, CT 06457-3359 | 2017-05-12 |
| 1225403710 | Lloyd Cloud Therapy Services, LLC | Community/Behavioral Health | 363 Main St, Suite 512 5th Floor, Middletown, CT 06457-3359 | 2015-12-09 |
| 1508237199 | Stephane Pady Clermont | Nurse Practitioner | 363 Main St, Middletown, CT 06457-3359 | 2015-10-08 |
| 1386896975 | Erika Moses | Social Worker | 363 Main St, # 513, Middletown, CT 06457-3359 | 2008-10-15 |
| 1740335306 | Laurence Antosz | Psychologist | 363 Main St, Suite 405, Middletown, CT 06457-3359 | 2007-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699391961 | Meghan Harrington | Behavior Technician | 101 Centerpoint Drive #243, Middletown, CT 06457 | 2020-06-22 |
| 1427619626 | Collaborative Aba Services, LLC | Behavioral Analyst | 515 Centerpoint Drive, Suite 205, Middletown, CT 06457 | 2019-06-27 |
| 1376100339 | Kimberly Tynik | Pharmacist | 451 Fowler Ave, Middletown, CT 06457 | 2019-05-24 |
| 1184101263 | Tabrez Adil | Dentist | 675 Main St., Middletown, CT 06457 | 2018-07-23 |
| 1326535337 | Rehan Khan | Non-emergency Medical Transport (VAN) | 765 Country Club Rd, Middletown, CT 06457 | 2018-04-16 |
| 1366950206 | State of Connecticut | Psychiatric Hospital | 70 O'brien Drive, Middletown, CT 06457 | 2018-01-12 |
| 1902324536 | Cynthia Tine | Physical Therapy Assistant | 628 Congdon Street, Middletown, CT 06457 | 2017-09-04 |
| 1619494390 | Nathan Douglas Roy | Specialist/Technologist | 431 Briarwood Lane, Middletown, CT 06457 | 2017-08-24 |
| 1598286502 | Rachel Hoffman Whelen | Registered Nurse | 420 Saybrook Road, Suite A, Middletown, CT 06457 | 2017-06-29 |
| 1003358326 | Rebecca Rotondo | Social Worker | 230 Main Street Extension, Act Team, Gilead Community Services, Middletown, CT 06457 | 2016-11-17 |
| Find all providers in zip 06457 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740802917 | Briana Haut | Psychologist | 416 Rederick Ln, Middletown, DE 19709-9981 | 2020-05-11 |
| 1932628963 | Carrissa Phillippe Phipps | Psychologist | 424 High St, Middletown, CT 06457-2633 | 2017-09-11 |
| 1104082981 | Earl Eugene Walker Jr. | Psychologist | 9 Morning Dew Dr, Middletown, DE 19709-2419 | 2008-08-01 |
| 1013115633 | Christopher S. Rigling | Psychologist | 976 Newfield St, Middletown, CT 06457-1860 | 2007-07-05 |
| 1629138243 | Tara Marie Neavins | Psychologist | Silver St Dutton Home, River Valley Services, Middletown, CT 06457 | 2006-12-12 |
| 1992865695 | Ronald Demakovsky | Psychologist | 351 Silver Street, River Valley Services Dutton Home, Middletown, CT 06457 | 2006-12-11 |
| 1710059472 | Karen J Gutheit | Psychologist | 210 East Main Street, Middletown, NY 10940 | 2006-11-15 |
| 1417028564 | David L Bloch | Psychologist | 52 Grand Ave, Middletown, NY 10940-3925 | 2006-11-12 |
| 1659461648 | Christian Counseling Service Inc | Psychologist | 758 East Main St Suite #1, Middletown, NY 10940 | 2006-10-13 |
| 1376588772 | Laurie Stevens | Psychologist | 300 Plaza Middlesex, 3rd Floor, Middletown, CT 06457 | 2006-06-19 |
| Find all providers in MIDDLETOWN | ||||
| City | MIDDLETOWN |
| Zip Code | 06457 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.