Provider Demographics
NPI:1619910676
Name:WOLK, DONALD J (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:J
Last Name:WOLK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 RIVERGATE WOODS
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-3616
Mailing Address - Country:US
Mailing Address - Phone:203-761-6700
Mailing Address - Fax:203-761-6700
Practice Address - Street 1:7 WHITNEY STREET EXT
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3761
Practice Address - Country:US
Practice Address - Phone:203-761-6700
Practice Address - Fax:203-761-6700
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP368763OtherOXFORD
CT060000308CT01OtherANTHEM BC/BS
CTP368763OtherOXFORD