Provider Demographics
NPI:1649402462
Name:WOLF, ERIKA JANE (PHD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:JANE
Last Name:WOLF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S HUNTINGTON AVE
Mailing Address - Street 2:(116B-4)
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4817
Mailing Address - Country:US
Mailing Address - Phone:857-364-4083
Mailing Address - Fax:857-364-4501
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:(116B-4)
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:857-364-4083
Practice Address - Fax:857-364-4501
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01220103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical