MEDICARE: DIANA A. WOLF M.A., BCBA, LBA

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1619202850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA A. WOLF M.A., BCBA, LBA

Provider Business Mailing Address
First Line	:	7090 SAMUEL MORSE DR STE 100
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-3444
Country	:	US
Telephone Number	:	888-344-5977
Fax Number	:

Provider Business Practice Location Address
First Line	:	7934 NOTTINGHAM WAY
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6761
Country	:	US
Telephone Number	:	443-928-1753
Fax Number	:

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

Provider Enumeration Date	:	10/06/2009
Last Update Date	:	01/31/2023

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