Provider Demographics
NPI:1487847687
Name:WOLF, WILLIAM ROBERT (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBERT
Last Name:WOLF
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5875 E CALLE DEL CIERVO
Mailing Address - Street 2:POSITIVE CHANGE COUNSELING
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-1812
Mailing Address - Country:US
Mailing Address - Phone:520-577-0111
Mailing Address - Fax:520-577-6767
Practice Address - Street 1:5875 E CALLE DEL CIERVO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-1812
Practice Address - Country:US
Practice Address - Phone:520-577-0111
Practice Address - Fax:520-299-8780
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-13321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQ35544Medicare UPIN
AZZ101149Medicare PIN