Provider Demographics
NPI:1902040884
Name:WOLF, ELAINE M (LMFT, MSW)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:M
Last Name:WOLF
Suffix:
Gender:F
Credentials:LMFT, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 OAK ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1652
Mailing Address - Country:US
Mailing Address - Phone:315-296-5799
Mailing Address - Fax:
Practice Address - Street 1:214 KENSINGTON PL
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-3308
Practice Address - Country:US
Practice Address - Phone:315-296-5799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000535-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist