MEDICARE: MARCIE J WOOD LMFT

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	106H00000X	Marriage & Family Therapist	MF000822	PA

General Provider Information

NPI Number	:	1477945525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIE J WOOD LMFT

Provider Business Mailing Address
First Line	:	309 S 51ST ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-1605
Country	:	US
Telephone Number	:	215-514-5766
Fax Number	:

Provider Business Practice Location Address
First Line	:	5050 BALTIMORE AVE UNIT 14
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-3302
Country	:	US
Telephone Number	:	267-225-5298
Fax Number	:

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

Provider Enumeration Date	:	02/26/2015
Last Update Date	:	12/02/2021

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