Provider Demographics
NPI:1003543828
Name:WOOD, VERONICA KAITLYN (LMSW)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:KAITLYN
Last Name:WOOD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ALEXANDER
Other - Middle Name:JAYE
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:922 FANNIN ST APT 108
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-6606
Mailing Address - Country:US
Mailing Address - Phone:903-267-0934
Mailing Address - Fax:
Practice Address - Street 1:1200 HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-3914
Practice Address - Country:US
Practice Address - Phone:575-835-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2022-0429104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker