Provider Demographics
NPI:1629197306
Name:WOODWORTH, HENRY FOREST (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:FOREST
Last Name:WOODWORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:143 CADYCENTRE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1119
Mailing Address - Country:US
Mailing Address - Phone:248-348-0333
Mailing Address - Fax:248-348-2333
Practice Address - Street 1:143 CADYCENTRE
Practice Address - Street 2:SUITE 302
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1119
Practice Address - Country:US
Practice Address - Phone:248-348-0333
Practice Address - Fax:248-348-2333
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010479472084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF06452Medicare UPIN