Provider Demographics
NPI:1629399365
Name:WING, JASON ALLEN
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ALLEN
Last Name:WING
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 1:66 PITCHERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HUBBARDSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01452-1632
Mailing Address - Country:US
Mailing Address - Phone:978-632-7985
Mailing Address - Fax:
Practice Address - Street 1:66 PITCHERVILLE ROAD
Practice Address - Street 2:
Practice Address - City:HUBBARDSTON
Practice Address - State:MA
Practice Address - Zip Code:01452
Practice Address - Country:US
Practice Address - Phone:978-632-7985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor