Healthcare Provider Details

I. General information

NPI: 1164948873
Provider Name (Legal Business Name): JEROME WACHTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 BERKSHIRE BLVD OFC 110
WYOMISSING PA
19610-1248
US

IV. Provider business mailing address

1105 BERKSHIRE BLVD OFC 110
WYOMISSING PA
19610-1248
US

V. Phone/Fax

Practice location:
  • Phone: 610-374-4963
  • Fax: 610-378-5403
Mailing address:
  • Phone: 610-374-4963
  • Fax: 610-378-5403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC015530
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: