Provider Demographics
NPI:1053856823
Name:S.J. WOODWARD PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:S.J. WOODWARD PSYCHOTHERAPY, LLC
Other - Org Name:SARAH J WOODWARD, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-561-9559
Mailing Address - Street 1:PO BOX 1434
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-1434
Mailing Address - Country:US
Mailing Address - Phone:240-561-9559
Mailing Address - Fax:240-718-2097
Practice Address - Street 1:22530 WASHINGTON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3898
Practice Address - Country:US
Practice Address - Phone:240-561-9559
Practice Address - Fax:240-718-2097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD177731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1039873 00Medicaid