Provider Demographics
NPI:1093190910
Name:WOLF, LILY (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LILY
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 N GOODMAN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1554
Mailing Address - Country:US
Mailing Address - Phone:706-614-3615
Mailing Address - Fax:
Practice Address - Street 1:16 N GOODMAN ST STE 300
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1554
Practice Address - Country:US
Practice Address - Phone:706-614-3615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001005-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist