MEDICARE: JEROME WACHTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YP2500X	Professional Counselor	PC015530	PA

General Provider Information

NPI Number	:	1164948873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME WACHTER

Provider Business Mailing Address
First Line	:	1105 BERKSHIRE BLVD OFC 110
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-1248
Country	:	US
Telephone Number	:	610-374-4963
Fax Number	:	610-378-5403

Provider Business Practice Location Address
First Line	:	1105 BERKSHIRE BLVD OFC 110
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-1248
Country	:	US
Telephone Number	:	610-374-4963
Fax Number	:	610-378-5403

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	12/03/2025

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