Provider Demographics
NPI:1871719864
Name:WOLFE, JEFFREY B (PHD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:B
Last Name:WOLFE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:B
Other - Last Name:WOLFE & ASSOCIATES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:5548 GRUBBS RD
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-9769
Mailing Address - Country:US
Mailing Address - Phone:724-444-8490
Mailing Address - Fax:
Practice Address - Street 1:103 N MEADOWS DR
Practice Address - Street 2:SUITE 210
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8369
Practice Address - Country:US
Practice Address - Phone:724-935-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002648L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA199755Medicare ID - Type UnspecifiedMEDICARE
PAR06622Medicare UPIN