Provider Demographics
NPI:1174296503
Name:WOODLEY, MYRON (LMSW)
Entity Type:Individual
Prefix:
First Name:MYRON
Middle Name:
Last Name:WOODLEY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 METROPOLITAN AVE APT 5F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6129
Mailing Address - Country:US
Mailing Address - Phone:347-835-1684
Mailing Address - Fax:
Practice Address - Street 1:1515 METROPOLITAN AVE APT 5F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-6129
Practice Address - Country:US
Practice Address - Phone:347-835-1684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1382586104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker