Provider Demographics
NPI:1407948615
Name:WOODRING, KIRK J (MSW,LICSW,CGP)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:J
Last Name:WOODRING
Suffix:
Gender:M
Credentials:MSW,LICSW,CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SANDGULLY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01373-7304
Mailing Address - Country:US
Mailing Address - Phone:413-773-7089
Mailing Address - Fax:
Practice Address - Street 1:342 BIRNIE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1104
Practice Address - Country:US
Practice Address - Phone:413-747-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10291731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WOP21508Medicare ID - Type Unspecified