Provider Demographics
NPI:1003038829
Name:WOLF, RONALD KENT (LSW)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:KENT
Last Name:WOLF
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-4485
Mailing Address - Country:US
Mailing Address - Phone:717-306-6615
Mailing Address - Fax:717-238-7894
Practice Address - Street 1:1100 S CAMERON ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-2547
Practice Address - Country:US
Practice Address - Phone:717-238-7662
Practice Address - Fax:717-238-7894
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW005115E101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health