MEDICARE: MR. JUDITH D. WOOD L.I.S.W.

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
1	1041C0700X	Clinical Social Worker	1.0005025	OH

General Provider Information

NPI Number	:	1740477272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUDITH D. WOOD L.I.S.W.

Provider Business Mailing Address
First Line	:	11811 SHAKER BLVD
Second Line	:	SUITE 220
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1931
Country	:	US
Telephone Number	:	216-229-2420
Fax Number	:	216-229-2474

Provider Business Practice Location Address
First Line	:	11811 SHAKER BLVD
Second Line	:	SUITE 220
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1931
Country	:	US
Telephone Number	:	216-229-2420
Fax Number	:	216-229-2474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	09/28/2007

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