Provider Demographics
NPI:1295179794
Name:WOLF, STEVE R (PHDS)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:R
Last Name:WOLF
Suffix:
Gender:M
Credentials:PHDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3416
Mailing Address - Country:US
Mailing Address - Phone:310-479-1143
Mailing Address - Fax:310-455-2727
Practice Address - Street 1:1530 GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3416
Practice Address - Country:US
Practice Address - Phone:310-479-1143
Practice Address - Fax:310-455-2727
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10230103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical