Individual
MR. JEREMY S. WAMPLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, LADC
Contact information
Practice address
205 ORANGE ST, NEW HAVEN, CT 06510-2069
(203) 776-9900
(203) 787-5599
Mailing address
21 RIDGEWOOD RD, WALLINGFORD, CT 06492-2116
(203) 623-3491
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
000930
CT
1041C0700X
Clinical Social Worker
Primary
007668
CT
Other
Enumeration date
10/31/2008
Last updated
10/17/2012
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