Provider Demographics
NPI:1639252612
Name:WOLF, HARVEY M (PSYD)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:M
Last Name:WOLF
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 S WILKE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1532
Mailing Address - Country:US
Mailing Address - Phone:847-259-2020
Mailing Address - Fax:847-259-2078
Practice Address - Street 1:115 S WILKE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1532
Practice Address - Country:US
Practice Address - Phone:847-259-2020
Practice Address - Fax:847-259-2078
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK22040Medicare ID - Type UnspecifiedMEDICARE PROVIDER #