Healthcare Provider Details

I. General information

NPI: 1699463034
Provider Name (Legal Business Name): STEPHAN PATRICK WOLFERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 MAIN ST FL 400
SPRINGFIELD MA
01103-1063
US

IV. Provider business mailing address

58 MAPLE HILL RD
WEST STOCKBRIDGE MA
01266-9354
US

V. Phone/Fax

Practice location:
  • Phone: 413-739-5572
  • Fax:
Mailing address:
  • Phone: 323-533-2847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: