Provider Demographics
NPI:1528104288
Name:WECHTER, JOHN DAVID (EDD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:WECHTER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-3840
Mailing Address - Country:US
Mailing Address - Phone:617-497-9362
Mailing Address - Fax:617-497-9363
Practice Address - Street 1:1280 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3840
Practice Address - Country:US
Practice Address - Phone:617-497-9362
Practice Address - Fax:617-497-9363
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2902103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist