Healthcare Provider Details

I. General information

NPI: 1871693390
Provider Name (Legal Business Name): BRUCE WOODWARD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 07/14/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 STRAFFORD AVENUE SUITE 1
WAYNE PA
19087
US

IV. Provider business mailing address

PO BOX 7175
SAINT DAVIDS PA
19087-7175
US

V. Phone/Fax

Practice location:
  • Phone: 610-688-1650
  • Fax:
Mailing address:
  • Phone: 610-688-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS003235L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS003235L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS003235L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: