Provider Demographics
NPI:1720183783
Name:WOLPER, JEFFREY (PHD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:WOLPER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 JOHN F KENNEDY BLVD
Mailing Address - Street 2:SUITE 605
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-7421
Mailing Address - Country:US
Mailing Address - Phone:267-977-0850
Mailing Address - Fax:215-322-6067
Practice Address - Street 1:1800 JOHN F KENNEDY BLVD
Practice Address - Street 2:SUITE 605
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-7421
Practice Address - Country:US
Practice Address - Phone:267-977-0850
Practice Address - Fax:215-322-6067
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005921L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA668005OtherPA BLUE SHIELD
PA0500938000OtherPERSONAL CHOICE