Healthcare Provider Details

I. General information

NPI: 1558617225
Provider Name (Legal Business Name): NICHOLAS AARON WOOD PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 EDGMONT AVE
CHESTER PA
19013-5038
US

IV. Provider business mailing address

2304 EDGMONT AVE
CHESTER PA
19013-5038
US

V. Phone/Fax

Practice location:
  • Phone: 610-872-9101
  • Fax:
Mailing address:
  • Phone: 215-525-8654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS017221
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: