Provider Demographics
NPI:1215014063
Name:WOODARD, MARTHA (PSYD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:WOODARD
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 1:35 POST OFFICE PARK
Mailing Address - Street 2:SUITE 3504
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1172
Mailing Address - Country:US
Mailing Address - Phone:413-596-6922
Mailing Address - Fax:
Practice Address - Street 1:35 POST OFFICE PARK
Practice Address - Street 2:SUITE 3504
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1172
Practice Address - Country:US
Practice Address - Phone:413-596-6922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6995103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05842OtherBLUE CROSS/BLUE SHIELD
MA24588OtherHEALTH NEW ENGLAND
MA093488OtherVALUE OPTIONS
MA3081091OtherCIGNA BEHAVIORAL HEALTH
MA24588OtherHEALTH NEW ENGLAND