Provider Demographics
NPI:1619167145
Name:WOOLDRIDGE, TOM D JR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:D
Last Name:WOOLDRIDGE
Suffix:JR
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 1:2041 BANCROFT WAY
Mailing Address - Street 2:SUITE 307
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1405
Mailing Address - Country:US
Mailing Address - Phone:510-982-1852
Mailing Address - Fax:
Practice Address - Street 1:2041 BANCROFT WAY
Practice Address - Street 2:SUITE 307
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1405
Practice Address - Country:US
Practice Address - Phone:510-982-1852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25475103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical