Provider Demographics
NPI:1619188083
Name:WOLFF, GLENN J (LCSW)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:J
Last Name:WOLFF
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 1:6 NASSAU PL # 3
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2526
Mailing Address - Country:US
Mailing Address - Phone:203-249-3313
Mailing Address - Fax:
Practice Address - Street 1:2001 W MAIN ST
Practice Address - Street 2:SUITE 106E
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-4501
Practice Address - Country:US
Practice Address - Phone:203-249-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0063941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical