Provider Demographics
NPI:1346460516
Name:WOODRUFF, GUY CARRERE (PHD)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:CARRERE
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HUMPHREYS AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070
Mailing Address - Country:US
Mailing Address - Phone:856-678-6954
Mailing Address - Fax:856-678-4458
Practice Address - Street 1:6 HUMPHREYS AVE
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070
Practice Address - Country:US
Practice Address - Phone:856-678-6954
Practice Address - Fax:856-678-4458
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI01970103TC0700X
PAPS004123L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ622121Medicare ID - Type Unspecified
PA102569Medicare ID - Type Unspecified