Provider Demographics
NPI:1396904645
Name:WOLFSON, ABBY (PHD)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:WOLFSON
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 1:248 THE UPLANDS
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2834
Mailing Address - Country:US
Mailing Address - Phone:510-985-0655
Mailing Address - Fax:
Practice Address - Street 1:248 THE UPLANDS
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2834
Practice Address - Country:US
Practice Address - Phone:510-985-0655
Practice Address - Fax:510-654-8209
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3962103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist