Provider Demographics
NPI:1881601169
Name:WIGON, JOSEPH (MSW LICSW)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:WIGON
Suffix:
Gender:M
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 CENTRE ST
Mailing Address - Street 2:UNIT 3
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3020
Mailing Address - Country:US
Mailing Address - Phone:617-323-7700
Mailing Address - Fax:
Practice Address - Street 1:1020 CENTRE ST
Practice Address - Street 2:UNIT 3
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3020
Practice Address - Country:US
Practice Address - Phone:617-323-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1133911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical