Provider Demographics
NPI:1134325905
Name:WOODMANSEE, MARLENA F (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARLENA
Middle Name:F
Last Name:WOODMANSEE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2541 TREVILIAN WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2323
Mailing Address - Country:US
Mailing Address - Phone:502-905-2541
Mailing Address - Fax:502-454-2307
Practice Address - Street 1:2915 FRANKFORT AVE STE D
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2682
Practice Address - Country:US
Practice Address - Phone:502-905-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1194103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist