Provider Demographics
NPI:1164076048
Name:WOLF-GRAMZOW, SARAH DYANNE (LMFT, PHD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:DYANNE
Last Name:WOLF-GRAMZOW
Suffix:
Gender:F
Credentials:LMFT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1310
Mailing Address - Country:US
Mailing Address - Phone:315-308-0854
Mailing Address - Fax:
Practice Address - Street 1:113 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1310
Practice Address - Country:US
Practice Address - Phone:315-308-0854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003188106H00000X
NY001588106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist