Provider Demographics
NPI:1437817269
Name:PUCHALSKY, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:PUCHALSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WARDS RAVINE WAY
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-9398
Mailing Address - Country:US
Mailing Address - Phone:908-670-5843
Mailing Address - Fax:
Practice Address - Street 1:1881 WORCESTER RD STE 100
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5410
Practice Address - Country:US
Practice Address - Phone:908-670-5843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty