Provider Demographics
NPI:1629114111
Name:WOODCOCK, CHERYL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:WOODCOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28W SHORTCUT RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17074-8721
Mailing Address - Country:US
Mailing Address - Phone:717-567-3524
Mailing Address - Fax:717-567-3581
Practice Address - Street 1:28W SHORTCUT RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:PA
Practice Address - Zip Code:17074-8721
Practice Address - Country:US
Practice Address - Phone:717-567-3524
Practice Address - Fax:717-567-3581
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0156331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019436680001Medicaid
PA110918Medicare PIN