Miryam Welbourne, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3491 Issued in CT

Practice address

363 Main St
Middletown, CT 06457-3359

Phone

(203) 836-1794

Fax

(888) 600-3738

NPI assigned

Aug 11, 2015

Last updated

Dec 12, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dr. Miryam Welbourne Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Single Step, LLC

  • Social Worker
  • Middletown, CT
  • NPI 1518494202
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1439251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544572800000",
    "number": "1811363062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 STRICKLAND RD",
            "city": "MIDDLEFIELD",
            "state": "CT",
            "postal_code": "064551225",
            "telephone_number": "203-836-1794",
            "fax_number": "888-600-3738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "363 MAIN ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573359",
            "telephone_number": "203-836-1794",
            "fax_number": "888-600-3738"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "261 Bradley St",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065101110",
            "country_code": "US",
            "telephone_number": "203-836-1794",
            "fax_number": "888-600-3738",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WELBOURNE",
        "first_name": "MIRYAM",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-11",
        "last_updated": "2018-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CT",
            "license": "3491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008061424",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRYAM",
            "last_name": "WELBOURNE",
            "prefix": "DR.",
            "credential": "PSY.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Laura Wernick, CADC
• Wesleyan University (Weslyan Sports Medicine)

• Psychologist in Middletown, CT
• Providers in Middletown, CT by specialty
• Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.