Provider Demographics
NPI:1902359615
Name:WOLFF PSYCHOTHERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:WOLFF PSYCHOTHERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LADAC
Authorized Official - Phone:505-507-1022
Mailing Address - Street 1:6324 LOFTUS AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2718
Mailing Address - Country:US
Mailing Address - Phone:505-507-1022
Mailing Address - Fax:505-323-5651
Practice Address - Street 1:6324 LOFTUS AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-369-6206
Practice Address - Fax:505-323-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0179961101YA0400X
NMC-085461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty