Provider Demographics
NPI:1588239107
Name:BODZIOCH- WOOLER, JUDITH BRONISLAWIA (MMHC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:BRONISLAWIA
Last Name:BODZIOCH- WOOLER
Suffix:
Gender:F
Credentials:MMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MOLLUSK DR E
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-5016
Mailing Address - Country:US
Mailing Address - Phone:401-212-9899
Mailing Address - Fax:
Practice Address - Street 1:200 CENTERVILLE RD STE 11
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-0204
Practice Address - Country:US
Practice Address - Phone:401-477-9446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty