Provider Demographics
NPI:1669859120
Name:WOOD, BENJAMIN TYLER (PHD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:TYLER
Last Name:WOOD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MAYO ST
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6052
Mailing Address - Country:US
Mailing Address - Phone:413-242-6589
Mailing Address - Fax:
Practice Address - Street 1:240 ELM ST FL 23
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2935
Practice Address - Country:US
Practice Address - Phone:413-242-6589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3343103T00000X
MA10107103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist