MEDICARE: DR. TOM D WOOLDRIDGE JR. PSYD

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	103TC0700X	Clinical Psychologist	PSY25475	CA

General Provider Information

NPI Number	:	1619167145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOM D WOOLDRIDGE JR. PSYD

Provider Business Mailing Address
First Line	:	2041 BANCROFT WAY
Second Line	:	SUITE 307
City	:	BERKELEY
State	:	CA
Zip	:	94704-1405
Country	:	US
Telephone Number	:	510-982-1852
Fax Number	:

Provider Business Practice Location Address
First Line	:	2041 BANCROFT WAY
Second Line	:	SUITE 307
City	:	BERKELEY
State	:	CA
Zip	:	94704-1405
Country	:	US
Telephone Number	:	510-982-1852
Fax Number	:

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

Provider Enumeration Date	:	07/31/2007
Last Update Date	:	01/22/2013

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