Healthcare Provider Details

I. General information

NPI: 1174737589
Provider Name (Legal Business Name): BEATRICE LISABETH WOOD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 BRYANT ST
BUFFALO NY
14222-2006
US

IV. Provider business mailing address

36 BRUNSWICK ST
ROCHESTER NY
14607-2307
US

V. Phone/Fax

Practice location:
  • Phone: 716-878-7645
  • Fax: 716-888-3935
Mailing address:
  • Phone: 585-734-8116
  • Fax: 716-888-3935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number011685-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: