Provider Demographics
NPI:1447298559
Name:WOLFE, ALBERT MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:MICHAEL
Last Name:WOLFE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1050 NORTHGATE DR
Mailing Address - Street 2:SUITE 353
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2526
Mailing Address - Country:US
Mailing Address - Phone:415-456-7718
Mailing Address - Fax:415-456-7718
Practice Address - Street 1:1050 NORTHGATE DR
Practice Address - Street 2:SUITE 353
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2526
Practice Address - Country:US
Practice Address - Phone:415-456-7718
Practice Address - Fax:415-456-7718
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16496103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist