MEDICARE: NANCIE B WOLFE PH.D.

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	103TC1900X	Counseling Psychologist	PS 003857 L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15603/SS	OTHER	PA	CIGNA INSURANCE

General Provider Information

NPI Number	:	1730185778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCIE B WOLFE PH.D.

Provider Business Mailing Address
First Line	:	255 S 17TH ST
Second Line	:	STE 1111
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6231
Country	:	US
Telephone Number	:	215-735-3490
Fax Number	:	215-735-2520

Provider Business Practice Location Address
First Line	:	255 S 17TH ST
Second Line	:	STE 1111
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6231
Country	:	US
Telephone Number	:	215-735-3490
Fax Number	:	215-735-2520

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/09/2007

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