MEDICARE: MR. PAUL ANTHONY WOODARD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904004439	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0006359	OTHER	VA	TRICARE
3	287193	OTHER	VA	ANTHEM
4	291352	OTHER	VA	MDIPA
5	089857	OTHER	VA	SENTARA

General Provider Information

NPI Number	:	1023066826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL ANTHONY WOODARD LCSW

Provider Business Mailing Address
First Line	:	5812 MAYBROOK CT
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-6946
Country	:	US
Telephone Number	:	804-364-2819
Fax Number	:

Provider Business Practice Location Address
First Line	:	19254 ROGERS CLARK BLVD
Second Line	:
City	:	RUTHER GLEN
State	:	VA
Zip	:	22546-4010
Country	:	US
Telephone Number	:	804-633-9997
Fax Number	:	804-633-7031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	08/03/2010

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