Provider Demographics
NPI:1487236485
Name:WOLFF, LEVI YITZCHOK (LPC)
Entity type:Individual
Prefix:
First Name:LEVI
Middle Name:YITZCHOK
Last Name:WOLFF
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 MEADOWLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5317
Mailing Address - Country:US
Mailing Address - Phone:347-779-4086
Mailing Address - Fax:
Practice Address - Street 1:630 MEADOWLAND AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5317
Practice Address - Country:US
Practice Address - Phone:570-763-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
PAPC013261101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty