Provider Demographics
NPI:1578845178
Name:WOODEN, MARCIA YVETTE (LCAT)
Entity Type:Individual
Prefix:MISS
First Name:MARCIA
Middle Name:YVETTE
Last Name:WOODEN
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:283 SACKETT ST
Mailing Address - Street 2:2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4300
Mailing Address - Country:US
Mailing Address - Phone:718-795-7523
Mailing Address - Fax:
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:ROOM 5B202D
Practice Address - City:BROOKLYN
Practice Address - State:NEW YORK
Practice Address - Zip Code:11206
Practice Address - Country:UM
Practice Address - Phone:718-968-5868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001056225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist