MEDICARE: MRS. LAURA WOLFE LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	6079	CO
2	1041C0700X	Clinical Social Worker	993016	CO
3	1041C0700X	Clinical Social Worker	113479	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295700672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA WOLFE LICSW

Provider Business Mailing Address
First Line	:	10 OLYMPIA WAY
Second Line	:
City	:	ANDOVER
State	:	MA
Zip	:	01810-2207
Country	:	US
Telephone Number	:	781-879-9784
Fax Number	:

Provider Business Practice Location Address
First Line	:	599 NORTH AVE
Second Line	:	DOOR 8 2ND FLOOR
City	:	WAKEFIELD
State	:	MA
Zip	:	01880-1648
Country	:	US
Telephone Number	:	781-879-9784
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	12/30/2016

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