Provider Demographics
NPI:1902953482
Name:WOLFE, THOMAS W (LICSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:W
Last Name:WOLFE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-2717
Mailing Address - Country:US
Mailing Address - Phone:508-653-0193
Mailing Address - Fax:
Practice Address - Street 1:122 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-2717
Practice Address - Country:US
Practice Address - Phone:508-653-0193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1036221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP01452OtherBCBS PROVIDER #