Provider Demographics
NPI:1760034797
Name:WOLFE, JARED (BCBA, LABA)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:WOLFE
Suffix:
Gender:M
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SANTILLI LN
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1594
Mailing Address - Country:US
Mailing Address - Phone:508-889-4842
Mailing Address - Fax:
Practice Address - Street 1:45 POND ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1627
Practice Address - Country:US
Practice Address - Phone:617-943-0137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2746103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst