Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 03585 | NJ |
N | 103TC1900X | Counseling Psychologist | PS-006490-L | PA |
NPI | 1033102892 |
---|---|
Provider Name | Dr. Susan Wolf |
First Address | Cherry Hill, NJ 08002-1915 |
Second Address | Cherry Hill, NJ 08034-1912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 16/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
133 | PBH (01) | NJ |
153300 | MHN (01) | NJ |