Provider Demographics
NPI:1477945525
Name:WOOD, MARCIE J (LMFT)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:J
Last Name:WOOD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 S 51ST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1605
Mailing Address - Country:US
Mailing Address - Phone:215-514-5766
Mailing Address - Fax:
Practice Address - Street 1:5050 BALTIMORE AVE UNIT 14
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3302
Practice Address - Country:US
Practice Address - Phone:267-225-5298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000822106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist