Provider Demographics
NPI:1336400506
Name:WOLFE-LYGA, KATHERINE E (MS, LMHC, ACS)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:WOLFE-LYGA
Suffix:
Gender:F
Credentials:MS, LMHC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2326
Mailing Address - Country:US
Mailing Address - Phone:315-480-2929
Mailing Address - Fax:315-312-5416
Practice Address - Street 1:5016 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2326
Practice Address - Country:US
Practice Address - Phone:315-480-2929
Practice Address - Fax:315-312-5416
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004919101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health