Provider Demographics
NPI:1003964297
Name:WOLF, EDITH S (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDITH
Middle Name:S
Last Name:WOLF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 SOUTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7125
Mailing Address - Country:US
Mailing Address - Phone:410-897-0119
Mailing Address - Fax:410-897-0119
Practice Address - Street 1:2903 SOUTHAVEN DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7125
Practice Address - Country:US
Practice Address - Phone:410-897-0119
Practice Address - Fax:410-897-0119
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03683103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist