Healthcare Provider Details

I. General information

NPI: 1780240051
Provider Name (Legal Business Name): VICTORIA ANN WOODRUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W 40TH ST STE 358
BALTIMORE MD
21211-2111
US

IV. Provider business mailing address

1115 BERNOUDY RD
WHITE HALL MD
21161-9415
US

V. Phone/Fax

Practice location:
  • Phone: 410-816-4097
  • Fax: 484-805-7166
Mailing address:
  • Phone: 443-827-5475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: