Provider Demographics
NPI:1902510209
Name:WOLFSON, LANCE IAN (MHC)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:IAN
Last Name:WOLFSON
Suffix:
Gender:M
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BEACH DR.
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1458
Mailing Address - Country:US
Mailing Address - Phone:516-236-7221
Mailing Address - Fax:
Practice Address - Street 1:7 BEACH DR.
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-1458
Practice Address - Country:US
Practice Address - Phone:516-236-7221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP110215101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor