Provider Demographics
NPI:1730185778
Name:WOLFE, NANCIE B (PHD)
Entity type:Individual
Prefix:
First Name:NANCIE
Middle Name:B
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S 17TH ST
Mailing Address - Street 2:STE 1111
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6231
Mailing Address - Country:US
Mailing Address - Phone:215-735-3490
Mailing Address - Fax:215-735-2520
Practice Address - Street 1:255 S 17TH ST
Practice Address - Street 2:STE 1111
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6231
Practice Address - Country:US
Practice Address - Phone:215-735-3490
Practice Address - Fax:215-735-2520
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 003857 L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA15603/SSOtherCIGNA INSURANCE
PAW5940Medicare ID - Type UnspecifiedMEDICARE
PA0062726000Medicare UPIN
PA050120Medicare UPIN
PAJ05940Medicare UPIN
PA15603/SSOtherCIGNA INSURANCE
PA46151409Medicare UPIN
PA4626276Medicare UPIN
PA2712047Medicare UPIN