MEDICARE: NICOLE MARIE WOLFRAM BSW, LSW

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	104100000X	Social Worker	2005746	OH

General Provider Information

NPI Number	:	1336946193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE WOLFRAM BSW, LSW

Provider Business Mailing Address
First Line	:	4623 WESLEY AVE STE G
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2272
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4623 WESLEY AVE STE G
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2272
Country	:	US
Telephone Number	:	513-772-5800
Fax Number	:

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

Provider Enumeration Date	:	02/28/2025
Last Update Date	:	12/12/2025

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