Healthcare Provider Details

I. General information

NPI: 1558745141
Provider Name (Legal Business Name): RENELLE WOLFF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 OLEANDER WAY S STE 4
SOUTH PASADENA FL
33707-2151
US

IV. Provider business mailing address

933 OLEANDER WAY S STE 4
SOUTH PASADENA FL
33707-2151
US

V. Phone/Fax

Practice location:
  • Phone: 703-469-8714
  • Fax:
Mailing address:
  • Phone: 703-469-8714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number61016
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1856
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12650
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number200001205
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904012441
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: