Provider Demographics
NPI:1316208259
Name:WOODWORTH, KERI ANN (MSED)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:ANN
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:18 HARPER STREET, APT. 2
Mailing Address - City:STAMFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12167-0096
Mailing Address - Country:US
Mailing Address - Phone:607-652-0035
Mailing Address - Fax:
Practice Address - Street 1:18 HARPER ST
Practice Address - Street 2:APT 2
Practice Address - City:STAMFORD
Practice Address - State:NY
Practice Address - Zip Code:12167-1040
Practice Address - Country:US
Practice Address - Phone:607-652-0035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist