Provider Demographics
NPI:1639384217
Name:ATWOOD, JOAN D (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:D
Last Name:ATWOOD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOAN
Other - Middle Name:D
Other - Last Name:ATWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:100 BACON RD
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1305
Mailing Address - Country:US
Mailing Address - Phone:516-770-4085
Mailing Address - Fax:
Practice Address - Street 1:542 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3223
Practice Address - Country:US
Practice Address - Phone:516-764-2526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0313411041C0700X
NY000277106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical