Provider Demographics
NPI:1841330016
Name:WOLFE, CONSTANCE DEBORAH (LISW)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:DEBORAH
Last Name:WOLFE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 HADDAM RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1531
Mailing Address - Country:US
Mailing Address - Phone:216-932-1979
Mailing Address - Fax:
Practice Address - Street 1:12429 CEDAR RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3199
Practice Address - Country:US
Practice Address - Phone:216-791-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 34141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical