Provider Demographics
NPI:1033771712
Name:WOOD, AMELIA PATRICIA
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:PATRICIA
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 FELTON ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-4132
Mailing Address - Country:US
Mailing Address - Phone:339-215-9125
Mailing Address - Fax:
Practice Address - Street 1:170 FELTON ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-4132
Practice Address - Country:US
Practice Address - Phone:339-215-9125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician