Provider Demographics
NPI:1871013193
Name:WOLFSON, HEIDI NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:NICOLE
Last Name:WOLFSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10720 BRIMHALL RD APT 125
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-3095
Mailing Address - Country:US
Mailing Address - Phone:805-816-7567
Mailing Address - Fax:
Practice Address - Street 1:2104 24TH ST STE 2
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3747
Practice Address - Country:US
Practice Address - Phone:805-816-7567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist