MEDICARE: DR. AMANDA P WOLFSON PSYD

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	103TC0700X	Clinical Psychologist	PY12202	FL
2	103T00000X	Psychologist	PY12202	FL

General Provider Information

NPI Number	:	1982463899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA P WOLFSON PSYD

Provider Business Mailing Address
First Line	:	952 MOCKINGBIRD LN APT 607
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-3443
Country	:	US
Telephone Number	:	305-318-0820
Fax Number	:

Provider Business Practice Location Address
First Line	:	7520 NW 5TH ST STE 200D
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33317-1613
Country	:	US
Telephone Number	:	305-318-0820
Fax Number	:

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

Provider Enumeration Date	:	03/14/2024
Last Update Date	:	01/14/2026

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