MEDICARE: AMBER WOODARD

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	101YM0800X	Mental Health Counselor		PA

General Provider Information

NPI Number	:	1710448519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER WOODARD

Provider Business Mailing Address
First Line	:	3806 CONSHOHOCKEN AVE FL 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2822
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3806 CONSHOHOCKEN AVE FL 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2822
Country	:	US
Telephone Number	:	267-246-9967
Fax Number	:

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

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	03/26/2019

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Directions to “ AMBER WOODARD ” Practice Location

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