Provider Demographics
NPI:1073812798
Name:WOODMAN, KATELYN MARGARET
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:MARGARET
Last Name:WOODMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KATELYN
Other - Middle Name:MARGARET
Other - Last Name:PFEIFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 FORTUNE BLVD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1750
Mailing Address - Country:US
Mailing Address - Phone:508-478-0207
Mailing Address - Fax:508-634-6984
Practice Address - Street 1:321 FORTUNE BLVD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1750
Practice Address - Country:US
Practice Address - Phone:508-478-0207
Practice Address - Fax:508-634-6984
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA178103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst