Provider Demographics
NPI:1659749968
Name:WOLF, CYNTHEIA
Entity Type:Individual
Prefix:
First Name:CYNTHEIA
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 SUMMER ST
Mailing Address - Street 2:SUITE 300A
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5359
Mailing Address - Country:US
Mailing Address - Phone:203-969-7799
Mailing Address - Fax:
Practice Address - Street 1:1275 SUMMER ST
Practice Address - Street 2:SUITE 300A
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5359
Practice Address - Country:US
Practice Address - Phone:203-969-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000379175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath