Provider Demographics
NPI:1639686082
Name:WANCZYK, KRYSTIN JEAN
Entity Type:Individual
Prefix:
First Name:KRYSTIN
Middle Name:JEAN
Last Name:WANCZYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRYSTIN
Other - Middle Name:JEAN
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:78 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARE
Mailing Address - State:MA
Mailing Address - Zip Code:01082-1318
Mailing Address - Country:US
Mailing Address - Phone:413-277-0537
Mailing Address - Fax:413-732-7075
Practice Address - Street 1:78 MAIN ST
Practice Address - Street 2:
Practice Address - City:WARE
Practice Address - State:MA
Practice Address - Zip Code:01082-1318
Practice Address - Country:US
Practice Address - Phone:413-277-0537
Practice Address - Fax:413-732-7075
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor