Provider Demographics
NPI:1225179245
Name:WOLFE, ROXANNA WHITNEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNA
Middle Name:WHITNEY
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ROXANNA
Other - Middle Name:W
Other - Last Name:WYAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:7988 OLD GEORGETOWN RD
Mailing Address - Street 2:8-A
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2481
Mailing Address - Country:US
Mailing Address - Phone:301-718-4544
Mailing Address - Fax:301-718-4545
Practice Address - Street 1:7988 OLD GEORGETOWN RD
Practice Address - Street 2:8-A
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2481
Practice Address - Country:US
Practice Address - Phone:301-718-4544
Practice Address - Fax:301-718-4545
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3384103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD958390Medicare ID - Type Unspecified