Provider Demographics
NPI:1962643700
Name:WOLFF, JENNIFER CHRISTINE (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHRISTINE
Last Name:WOLFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CHRISTINE
Other - Last Name:GORING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:APC 978
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-4318
Mailing Address - Fax:401-444-7865
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:POB 122
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-4515
Practice Address - Fax:401-444-7865
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
RIPS01126103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPS01126OtherRHODE ISLAND PROFESSIONAL LICENSE