Healthcare Provider Details

I. General information

NPI: 1033102892
Provider Name (Legal Business Name): SUSAN WOLF PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N KINGS HWY SUITE 304
CHERRY HILL NJ
08034-1912
US

IV. Provider business mailing address

405 GARDEN STATE DR
CHERRY HILL NJ
08002-1915
US

V. Phone/Fax

Practice location:
  • Phone: 856-482-7023
  • Fax:
Mailing address:
  • Phone: 856-482-7023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number03585
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS-006490-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: