Provider Demographics
NPI:1649597246
Name:WOLFE, MARTHA GUADALUPE (MFT)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:GUADALUPE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 ENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-4115
Mailing Address - Country:US
Mailing Address - Phone:626-991-3803
Mailing Address - Fax:
Practice Address - Street 1:74 US HIGHWAY 9
Practice Address - Street 2:SUITE 7
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-9209
Practice Address - Country:US
Practice Address - Phone:626-991-3803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69885106H00000X
NJ37FI00178500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist