Provider Demographics
NPI:1770832818
Name:WOODMAN, BARON
Entity Type:Individual
Prefix:
First Name:BARON
Middle Name:
Last Name:WOODMAN
Suffix:
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:PO BOX 370724
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-0724
Mailing Address - Country:US
Mailing Address - Phone:702-767-0579
Mailing Address - Fax:702-823-4781
Practice Address - Street 1:6759 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-2002
Practice Address - Country:US
Practice Address - Phone:702-467-1377
Practice Address - Fax:702-823-4781
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst