Provider Demographics
NPI:1558617225
Name:WOOD, NICHOLAS AARON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:AARON
Last Name:WOOD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-5038
Mailing Address - Country:US
Mailing Address - Phone:215-525-8654
Mailing Address - Fax:
Practice Address - Street 1:2304 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-5038
Practice Address - Country:US
Practice Address - Phone:610-872-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017221103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical