Basic Information
| Provider Information | |||||||||
| NPI: | 1326632696 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLFGANG | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | FRANCIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 MOHAWK DR | ||||||||
| Address2: | |||||||||
| City: | GIRARD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444201619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302190234 | ||||||||
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| Practice Location | |||||||||
| Address1: | 165 E PARK AVE | ||||||||
| Address2: | |||||||||
| City: | NILES | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444462352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305448005 | ||||||||
| FaxNumber: | 3305449379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2021 | ||||||||
| LastUpdateDate: | 02/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.