Healthcare Provider Details

I. General information

NPI: 1043022577
Provider Name (Legal Business Name): MATTHEW T WOODWARD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 DUNHAM RIDGE ROAD SUITE 3200-3350
BEVERLY MA
01915
US

IV. Provider business mailing address

25 STOCKER AVE
LYNN MA
01904-1226
US

V. Phone/Fax

Practice location:
  • Phone: 978-600-0816
  • Fax:
Mailing address:
  • Phone: 781-913-9280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW230836
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: