Basic Information
| Provider Information | |||||||||
| NPI: | 1073823373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLPERT | ||||||||
| FirstName: | JOAN | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MA, BC-DMT, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1508 SHEFFIELD LN | ||||||||
| Address2: | |||||||||
| City: | WYNNEWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190963727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106081470 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1060 FIRST AVE | ||||||||
| Address2: | SUITE 430 | ||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194061336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109920555 | ||||||||
| FaxNumber: | 6109921010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2010 | ||||||||
| LastUpdateDate: | 12/15/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | PC005177 | PA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.