Provider Demographics
NPI:1518065309
Name:WOLF, AUDREY L (MSSW)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:L
Last Name:WOLF
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 JANE STREET
Mailing Address - Street 2:#9F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-5157
Mailing Address - Country:US
Mailing Address - Phone:212-645-9498
Mailing Address - Fax:
Practice Address - Street 1:61 JANE STREET
Practice Address - Street 2:#9F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-5157
Practice Address - Country:US
Practice Address - Phone:212-645-9498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027349-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N1B491Medicare ID - Type Unspecified