Provider Demographics
NPI:1790516508
Name:WRONSKI, JEREMY MARTIN
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:MARTIN
Last Name:WRONSKI
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:J
Other - Last Name:WRONSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:203 LAKE PLYMOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:CT
Mailing Address - Zip Code:06782-2701
Mailing Address - Country:US
Mailing Address - Phone:203-501-7070
Mailing Address - Fax:
Practice Address - Street 1:411 CHANDLER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-3339
Practice Address - Country:US
Practice Address - Phone:508-799-0688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor