Provider Demographics
NPI:1972654069
Name:WOOLFOLK, ROBERT L (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:WOOLFOLK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 TURNER CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3426
Mailing Address - Country:US
Mailing Address - Phone:609-924-8362
Mailing Address - Fax:
Practice Address - Street 1:330 N HARRISON ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3524
Practice Address - Country:US
Practice Address - Phone:609-924-8362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1066103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ178114Medicare ID - Type Unspecified