Individual
DR. MIRYAM WELBOURNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
363 MAIN ST, MIDDLETOWN, CT 06457-3359
(203) 836-1794
(888) 600-3738
Mailing address
104 STRICKLAND RD, MIDDLEFIELD, CT 06455-1225
(203) 836-1794
(888) 600-3738
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3491
CT
103T00000X
Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008061424
—
CT
Enumeration date
08/11/2015
Last updated
12/12/2018
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