Healthcare Provider Details

I. General information

NPI: 1710519756
Provider Name (Legal Business Name): JOSHUA MICHAEL WREN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 CENTER ST STE 104
NORTHAMPTON MA
01060-3062
US

IV. Provider business mailing address

43 CENTER ST STE 104
NORTHAMPTON MA
01060-3062
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-6750
  • Fax:
Mailing address:
  • Phone: 413-992-7308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: