Provider Demographics
NPI:1790184026
Name:WOLF, SHIRA GAYLE
Entity Type:Individual
Prefix:MS
First Name:SHIRA
Middle Name:GAYLE
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 1:1009 FREDERICK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5055
Mailing Address - Country:US
Mailing Address - Phone:443-961-5119
Mailing Address - Fax:
Practice Address - Street 1:1009 FREDERICK RD STE 1
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-5055
Practice Address - Country:US
Practice Address - Phone:443-961-5119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD201171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical