Provider Demographics
NPI:1871898957
Name:WOLFE, LAURA ANN (MFT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 S BASCOM AVE
Mailing Address - Street 2:STE. 180
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-2569
Mailing Address - Country:US
Mailing Address - Phone:408-380-3027
Mailing Address - Fax:
Practice Address - Street 1:3190 S BASCOM AVE
Practice Address - Street 2:STE. 180
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2569
Practice Address - Country:US
Practice Address - Phone:408-380-3027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47347106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist