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NPI Code Detail

MEDICARE: MARY WOODS MFT

MEDICARE: MARY WOODS MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFT 33603CA

General Provider Information

NPI Number : 1124100193
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY WOODS MFT
Provider Business Mailing Address
First Line : 983 POINT ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92106-2038
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3211 JEFFERSON ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-4424
Country : US
Telephone Number : 619-683-3100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2006
Last Update Date : 07/08/2007

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Directions to “ MARY WOODS MFT” Practice Location

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