Provider Demographics
NPI:1699463034
Name:WOLFERT, STEPHAN PATRICK
Entity type:Individual
Prefix:
First Name:STEPHAN
Middle Name:PATRICK
Last Name:WOLFERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 MAPLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST STOCKBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01266-9354
Mailing Address - Country:US
Mailing Address - Phone:323-533-2847
Mailing Address - Fax:
Practice Address - Street 1:1695 MAIN ST FL 400
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1063
Practice Address - Country:US
Practice Address - Phone:413-739-5572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool