Provider Demographics
NPI:1376717652
Name:WOLF, CONSUELO GODINEZ (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CONSUELO
Middle Name:GODINEZ
Last Name:WOLF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4800 N MARINE DRIVE
Mailing Address - Street 2:THE SALVATION ARMY FAMILY AND COMMUNITY SERVICES
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640
Mailing Address - Country:US
Mailing Address - Phone:773-275-6233
Mailing Address - Fax:773-275-6288
Practice Address - Street 1:4800 N MARINE DRIVE
Practice Address - Street 2:THE SALVATION ARMY FAMILY AND COMMUNITY SERVICES
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-275-6233
Practice Address - Fax:773-275-6288
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health