=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336349349
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETH N. WOOD LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2007
-----------------------------------------------------
Last Update Date | 07/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 43 RACE POINT RD
-----------------------------------------------------
City | PROVINCETOWN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02657-1529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-487-5199
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1175
-----------------------------------------------------
City | TRURO
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02666-1175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-487-5199
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 1303
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 000988
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------