Provider Demographics
NPI:1912060039
Name:WOLFSON, LEE K (MED)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:K
Last Name:WOLFSON
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3397 MACARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1351
Mailing Address - Country:US
Mailing Address - Phone:412-897-2827
Mailing Address - Fax:
Practice Address - Street 1:4115 WILLIAM PENN HWY STE 201
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1887
Practice Address - Country:US
Practice Address - Phone:412-897-2827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008080L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018242250001Medicaid
PA846107Medicare ID - Type Unspecified
PA0018242250001Medicaid