Provider Demographics
NPI:1942421383
Name:WOLFE, ELIZABETH ELLEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ELLEN
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3210
Mailing Address - Country:US
Mailing Address - Phone:203-761-1014
Mailing Address - Fax:203-227-8861
Practice Address - Street 1:215 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3210
Practice Address - Country:US
Practice Address - Phone:203-761-1014
Practice Address - Fax:203-227-8861
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002286103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist