Healthcare Provider Details

I. General information

NPI: 1477225183
Provider Name (Legal Business Name): DEANA M WOLF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SPRUCE ST
SMITHTOWN NY
11787-1010
US

IV. Provider business mailing address

5 SPRUCE ST
SMITHTOWN NY
11787-1010
US

V. Phone/Fax

Practice location:
  • Phone: 631-742-7003
  • Fax:
Mailing address:
  • Phone: 631-742-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC019260
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number114097
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number099663
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: