Provider Demographics
NPI:1952446197
Name:WOLFSON, HAVI MICHELE (LCSW)
Entity Type:Individual
Prefix:
First Name:HAVI
Middle Name:MICHELE
Last Name:WOLFSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12401 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1085
Mailing Address - Country:US
Mailing Address - Phone:310-207-9896
Mailing Address - Fax:310-820-3595
Practice Address - Street 1:6505 WILSHIRE BLVD
Practice Address - Street 2:5TH FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4917
Practice Address - Country:US
Practice Address - Phone:323-761-8800
Practice Address - Fax:323-761-8801
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA224831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical