Provider Demographics
NPI:1851668818
Name:WOLF MEHLMAN PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:WOLF MEHLMAN PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF-MEHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-744-4494
Mailing Address - Street 1:31 S FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3455
Mailing Address - Country:US
Mailing Address - Phone:973-744-4494
Mailing Address - Fax:
Practice Address - Street 1:31 S FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3455
Practice Address - Country:US
Practice Address - Phone:973-744-4494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05479400251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health