Provider Demographics
NPI:1881576965
Name:WIMBERLY, JERRY
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:WIMBERLY
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 1:792 WEST ST APT A208
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1186
Mailing Address - Country:US
Mailing Address - Phone:229-291-6255
Mailing Address - Fax:
Practice Address - Street 1:225 FOXBOROUGH BLVD
Practice Address - Street 2:
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035-3062
Practice Address - Country:US
Practice Address - Phone:508-901-4685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health