Basic Information
| Provider Information | |||||||||
| NPI: | 1720145048 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOBCZAK-WELSH | ||||||||
| FirstName: | AUGUSTA | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, CRC, LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1669 INDIAN FALLS RD | ||||||||
| Address2: | |||||||||
| City: | CORFU | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140369734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857628347 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | GCMHS 5130 EAST MAIN ST RD | ||||||||
| Address2: | SUITE #2 | ||||||||
| City: | BATAVIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140203496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853441421 | ||||||||
| FaxNumber: | 5853448554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 002368 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.