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NPI Code Detail

MEDICARE: CHRISTIAN WULFF LICSW

MEDICARE: CHRISTIAN WULFF LICSW
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
11041C0700XClinical Social WorkerLICSW1141989MA
2390200000XStudent in an Organized Health Care Education/Training Program
3101Y00000XCounselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1390200000XOTHERWASTUDENT IN AN ORGANIZED HEALTH CARE EDUCATION/TRAINING PROGRAM

General Provider Information

NPI Number : 1760039788
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTIAN WULFF LICSW
Provider Business Mailing Address
First Line : 960 MASSACHUSETTS AVE STE 2
Second Line :
City : BOSTON
State : MA
Zip : 02118-2690
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1116 SUMMIT AVE
Second Line :
City : SEATTLE
State : WA
Zip : 98101-2831
Country : US
Telephone Number : 206-323-0930
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2019
Last Update Date : 06/03/2026

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Directions to “ CHRISTIAN WULFF LICSW” Practice Location

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