Provider Demographics
NPI:1790175669
Name:WOLKEN, NATHAN MERLE (MA, CRC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:MERLE
Last Name:WOLKEN
Suffix:
Gender:M
Credentials:MA, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-2921
Mailing Address - Country:US
Mailing Address - Phone:641-485-6520
Mailing Address - Fax:
Practice Address - Street 1:113 TREMONT ST
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-4753
Practice Address - Country:US
Practice Address - Phone:781-934-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health