Active NPI
Russel Wolf, LMHC
- Professional Counselor
- Cambridge, MA
National Provider Identifier
1225107758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- MH-1497-CC
- Practice address
- 929 Massachusetts Ave.
St. 103
Cambridge, MA 02139 - Phone
- (617) 774-6036
- NPI assigned
- Nov 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1497 | MA | |
| Professional Counselor | 101YP2500X | MH-1497-CC | MA | Primary |
Addresses
Primary practice location
929 Massachusetts Ave.
St. 103
Cambridge, MA 02139
Mailing address
1000 Jefferson St.
Ste. 2C
Lynchburg, VA 24504
Phone (617) 379-0496
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH-1497-CC | MA | MD | Professional Counselor |
| 1497 | MA | MD | Electroneurodiagnostic Specialist/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425340800000",
"number": "1225107758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 JEFFERSON ST.",
"address_2": "STE. 2C",
"city": "LYNCHBURG",
"state": "VA",
"postal_code": "24504",
"telephone_number": "617-379-0496",
"fax_number": "617-807-0958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "929 MASSACHUSETTS AVE.",
"address_2": "ST. 103",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "02139",
"telephone_number": "617-774-6036"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLF",
"first_name": "RUSSEL",
"credential": "LMHC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-07",
"last_updated": "2015-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "1497",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MA",
"license": "MH-1497-CC",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.