Active NPI
Jennifer Lynn Wolf, PH.D.
- Clinical Psychologist
- Melbourne, FL
National Provider Identifier
1700080686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY8640
- Practice address
- 3270 Suntree Blvd Ste 127
Melbourne, FL 32940-7522 - Phone
- (321) 372-8608
- NPI assigned
- Jun 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY 8640 | FL | |
| Psychologist | 103T00000X | 017546 | NY | |
| Clinical Psychologist | 103TC0700X | PY8640 | FL | Primary |
Addresses
Primary practice location
3270 Suntree Blvd Ste 127
Melbourne, FL 32940-7522
Mailing address
3270 Suntree Blvd Ste 127
Melbourne, FL 32940-7522
Other names 1
- Dr. Jennifer Lynn Wisneski
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY 8640 | FL | MD | Psychologist |
| 017546 | NY | MD | Psychologist |
| PY8640 | FL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wolf Psychological Services LLC | Current | Accepting new patients |
Locations
3270 Suntree Blvd
Ste 127
Melbourne, FL 32940
Phone (321) 372-8608
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Melbourne, FL
- NPI 1174086151
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623628800000",
"number": "1700080686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3270 SUNTREE BLVD STE 127",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329407522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3270 SUNTREE BLVD STE 127",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329407522",
"telephone_number": "321-372-8608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLF",
"first_name": "JENNIFER",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-13",
"last_updated": "2021-06-14",
"certification_date": "2021-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "PY 8640",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "017546",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY8640",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "WISNESKI",
"middle_name": "LYNN",
"prefix": "DR.",
"credential": "PH.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.