Provider Demographics
NPI:1972757821
Name:WOZNIAK, JESSICA A (PSY D)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:WOZNIAK
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:300 CAREW STREET
Practice Address - Street 2:STE 2
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2146
Practice Address - Country:US
Practice Address - Phone:413-794-9816
Practice Address - Fax:413-794-4945
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002890103T00000X
MA9194103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist