Individual
BARRY WOLF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
JACKWOLF LLC, 247 S. OCEAN BLVD, BOCA RATON, FL 33432
(561) 961-9225
Mailing address
247 S OCEAN BLVD UNIT B, BOCA RATON, FL 33432-6439
(561) 951-9225
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
646878
PHYSICIAN DIRECT
FL
Enumeration date
05/12/2020
Last updated
05/12/2020
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