Provider Demographics
NPI:1912118498
Name:WOLF, MARILEA A (LCSW)
Entity type:Individual
Prefix:
First Name:MARILEA
Middle Name:A
Last Name:WOLF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 HOFFMAN LN
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-2614
Mailing Address - Country:US
Mailing Address - Phone:916-863-0318
Mailing Address - Fax:916-863-0318
Practice Address - Street 1:5901 HOFFMAN LN
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-2614
Practice Address - Country:US
Practice Address - Phone:916-863-0318
Practice Address - Fax:916-863-0318
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS12141102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst