Provider Demographics
NPI:1780129098
Name:WOLF, STEPHANIE SUSANNE GENSER (JD PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:SUSANNE GENSER
Last Name:WOLF
Suffix:
Gender:F
Credentials:JD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5614 SHIELDS DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-3532
Mailing Address - Country:US
Mailing Address - Phone:202-255-2370
Mailing Address - Fax:
Practice Address - Street 1:5614 SHIELDS DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-3532
Practice Address - Country:US
Practice Address - Phone:202-255-2370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05511103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist