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NPI Code Detail

MEDICARE: WOODS PSYCHOLOGICAL, NEUROPSYCHOLOGICAL SERVICES,P.C.

MEDICARE: WOODS PSYCHOLOGICAL, NEUROPSYCHOLOGICAL SERVICES,P.C.
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
1103G00000XClinical Neuropsychologist
2103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1053900894
Entity Type Code : Organization
Provider Name (Legal Business Name) : WOODS PSYCHOLOGICAL, NEUROPSYCHOLOGICAL SERVICES,P.C.
Provider Business Mailing Address
First Line : 42 LAKE ST STE 1
Second Line :
City : HAMBURG
State : NY
Zip : 14075-4937
Country : US
Telephone Number : 970-688-0852
Fax Number :
Provider Business Practice Location Address
First Line : 42 LAKE ST STE 1
Second Line :
City : HAMBURG
State : NY
Zip : 14075-4937
Country : US
Telephone Number : 970-688-0852
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MRS. BONNIE J WOODS
Credential : PSYD
Telephone Number : 970-688-0852
Provider Enumeration Date : 01/15/2021
Last Update Date : 02/18/2021

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