MEDICARE: MELISSA A WOLF M.S. C.A.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	59354	DE

General Provider Information

NPI Number	:	1649553918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA A WOLF M.S. C.A.S.

Provider Business Mailing Address
First Line	:	80 GLADE CIR E
Second Line	:
City	:	REHOBOTH BEACH
State	:	DE
Zip	:	19971-4115
Country	:	US
Telephone Number	:	716-465-7093
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 GLADE CIR E
Second Line	:
City	:	REHOBOTH BEACH
State	:	DE
Zip	:	19971-4115
Country	:	US
Telephone Number	:	716-465-7093
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2011
Last Update Date	:	08/08/2014

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