Provider Demographics
NPI:1053494062
Name:HARVEY M. WOLF, PSY.D., CSC, P.C.
Entity Type:Organization
Organization Name:HARVEY M. WOLF, PSY.D., CSC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-259-2020
Mailing Address - Street 1:115 S WILKE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1532
Mailing Address - Country:US
Mailing Address - Phone:847-259-2020
Mailing Address - Fax:847-259-2078
Practice Address - Street 1:115 S WILKE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1532
Practice Address - Country:US
Practice Address - Phone:847-259-2020
Practice Address - Fax:847-259-2078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212482Medicare ID - Type UnspecifiedCORP PROVIDER #