Provider Demographics
NPI:1669661351
Name:WOLKOFF, JERALD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JERALD
Middle Name:
Last Name:WOLKOFF
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1269 JONATHAN LN
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2543
Mailing Address - Country:US
Mailing Address - Phone:516-783-7349
Mailing Address - Fax:
Practice Address - Street 1:1269 JONATHAN LN
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2543
Practice Address - Country:US
Practice Address - Phone:516-783-7349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0161111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical