Healthcare Provider Details

I. General information

NPI: 1437817269
Provider Name (Legal Business Name): JASON PUCHALSKY LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 09/29/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 WORCESTER RD STE 100
FRAMINGHAM MA
01701-5410
US

IV. Provider business mailing address

120 WARDS RAVINE WAY
ST JOHNS FL
32259-9398
US

V. Phone/Fax

Practice location:
  • Phone: 908-670-5843
  • Fax:
Mailing address:
  • Phone: 908-670-5843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128545
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: