Provider Demographics
NPI:1104307552
Name:WOLFSON, NEIL CRAIG (LCSW)
Entity type:Individual
Prefix:MR
First Name:NEIL
Middle Name:CRAIG
Last Name:WOLFSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 NW 13TH ST STE 222
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1619
Mailing Address - Country:US
Mailing Address - Phone:561-899-9420
Mailing Address - Fax:
Practice Address - Street 1:123 NW 13TH ST STE 222
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1619
Practice Address - Country:US
Practice Address - Phone:561-899-9420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW156351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical