Provider Demographics
NPI:1164948873
Name:WACHTER, JEROME
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:WACHTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 BERKSHIRE BLVD OFC 110
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1248
Mailing Address - Country:US
Mailing Address - Phone:610-374-4963
Mailing Address - Fax:610-378-5403
Practice Address - Street 1:1105 BERKSHIRE BLVD OFC 110
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1248
Practice Address - Country:US
Practice Address - Phone:610-374-4963
Practice Address - Fax:610-378-5403
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
PAPC015530101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor