Provider Demographics
NPI:1639677024
Name:WOLF, FRITZ MATTHEW
Entity Type:Individual
Prefix:
First Name:FRITZ
Middle Name:MATTHEW
Last Name:WOLF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3968 MEADOWBREEZE CT APT 31
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-4311
Mailing Address - Country:US
Mailing Address - Phone:727-204-9340
Mailing Address - Fax:
Practice Address - Street 1:3190 TYRONE BLVD N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-2919
Practice Address - Country:US
Practice Address - Phone:727-345-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst