Provider Demographics
NPI:1851072417
Name:WOLF, AMILIA (BA)
Entity Type:Individual
Prefix:
First Name:AMILIA
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30C GARDEN VILLAGE DR APT 3
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-3341
Mailing Address - Country:US
Mailing Address - Phone:716-785-9357
Mailing Address - Fax:
Practice Address - Street 1:2470 ALLEN AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14303-1908
Practice Address - Country:US
Practice Address - Phone:716-282-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)