Provider Demographics
NPI:1013040427
Name:WOLFSON, MICHELE CALLAHAN (MENTAL HEALTH COUNSE)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:CALLAHAN
Last Name:WOLFSON
Suffix:
Gender:F
Credentials:MENTAL HEALTH COUNSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:SOUTH WELLFLEET
Mailing Address - State:MA
Mailing Address - Zip Code:02663-0536
Mailing Address - Country:US
Mailing Address - Phone:508-349-3790
Mailing Address - Fax:508-349-3790
Practice Address - Street 1:130 LIEUTENANT'S ISLAND ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH WELLFLEET
Practice Address - State:MA
Practice Address - Zip Code:02663-0536
Practice Address - Country:US
Practice Address - Phone:508-349-3790
Practice Address - Fax:508-349-3790
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA894101YM0800X
MA503106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM1145OtherBCBS PROVIDER NUMBER