Provider Demographics
NPI:1427221456
Name:BOYD-WOODARD, MALISSA S (LCSW)
Entity Type:Individual
Prefix:
First Name:MALISSA
Middle Name:S
Last Name:BOYD-WOODARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 W MUSKEGON DR
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-3069
Mailing Address - Country:US
Mailing Address - Phone:317-468-6270
Mailing Address - Fax:317-468-6268
Practice Address - Street 1:120 W MCKENZIE RD
Practice Address - Street 2:SUITE F
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-3084
Practice Address - Country:US
Practice Address - Phone:317-468-6200
Practice Address - Fax:317-468-6201
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005520A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical