Provider Demographics
NPI:1871280735
Name:WETZEL, JAYA
Entity type:Individual
Prefix:
First Name:JAYA
Middle Name:
Last Name:WETZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BENJAMIN TRL
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-9747
Mailing Address - Country:US
Mailing Address - Phone:609-647-3846
Mailing Address - Fax:
Practice Address - Street 1:3 WOODLAND RD STE 119
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1710
Practice Address - Country:US
Practice Address - Phone:781-321-0645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician