Provider Demographics
NPI:1487041083
Name:WOLF, MICHAEL J (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:WOLF
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 NARROWS RD S APT 2B1
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3775
Mailing Address - Country:US
Mailing Address - Phone:732-330-2283
Mailing Address - Fax:
Practice Address - Street 1:2 NARROWS RD S APT 2B1
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3775
Practice Address - Country:US
Practice Address - Phone:732-330-2283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0899991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty