Provider Demographics
NPI:1659885556
Name:WOODS, EDWARD SR
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:WOODS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 SOUTH HARRISON STREET 12M
Mailing Address - Street 2:12M
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018
Mailing Address - Country:US
Mailing Address - Phone:973-972-7900
Mailing Address - Fax:
Practice Address - Street 1:183 SOUTH ORANGE AVENUE AVENUE
Practice Address - Street 2:LEVEL D
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-0710
Practice Address - Country:US
Practice Address - Phone:973-972-5479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor