Provider Demographics
NPI:1427033877
Name:WOLFORD, KAREN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:M
Last Name:WOLFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:A
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4347 OLYMPUS HTS
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-2460
Mailing Address - Country:US
Mailing Address - Phone:315-469-5528
Mailing Address - Fax:
Practice Address - Street 1:614 S SALINA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3524
Practice Address - Country:US
Practice Address - Phone:315-428-0125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007470103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52847BMedicare ID - Type UnspecifiedMEDICARE NUMBER