Provider Demographics
NPI:1124496062
Name:WOLFE, MARK (MED, MSW, LSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MED, MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 CONCORD PIKE
Mailing Address - Street 2:STE 204
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3645
Mailing Address - Country:US
Mailing Address - Phone:302-655-2627
Mailing Address - Fax:302-655-2613
Practice Address - Street 1:1601 CONCORD PIKE
Practice Address - Street 2:SUITE 68
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3612
Practice Address - Country:US
Practice Address - Phone:302-655-2627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00014801041C0700X
PASW130797104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker