Healthcare Provider Details

I. General information

NPI: 1942353438
Provider Name (Legal Business Name): KIMBERLY JEAN WOODCOCK L.M.H.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS KIMBERLY J MANIERO

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 01/15/2022
Certification Date: 01/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 MAIN ST UNIT 213
MEDWAY MA
02053-1584
US

IV. Provider business mailing address

165 MAIN ST UNIT 213
MEDWAY MA
02053-1584
US

V. Phone/Fax

Practice location:
  • Phone: 508-320-5165
  • Fax: 508-519-0051
Mailing address:
  • Phone: 508-320-5165
  • Fax: 508-519-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4694
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4694
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: