Healthcare Provider Details

I. General information

NPI: 1609527449
Provider Name (Legal Business Name): EMMA WOLFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 ENTERPRISE PKWY STE 250
BEACHWOOD OH
44122-7343
US

IV. Provider business mailing address

20650 FAIRMOUNT BLVD APT 9B
CLEVELAND OH
44118-4852
US

V. Phone/Fax

Practice location:
  • Phone: 216-765-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2304881
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2103642-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: