Provider Demographics
NPI:1790835841
Name:WOLFERT, JULIE ANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANNE
Last Name:WOLFERT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 SACRAMENTO ST # A
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2225
Mailing Address - Country:US
Mailing Address - Phone:415-308-9631
Mailing Address - Fax:
Practice Address - Street 1:2409 SACRAMENTO ST # A
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2225
Practice Address - Country:US
Practice Address - Phone:415-308-9631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17627103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL176270Medicare ID - Type Unspecified