Provider Demographics
NPI:1790878700
Name:WOODMAN, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
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 703
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-0703
Mailing Address - Country:US
Mailing Address - Phone:207-594-8433
Mailing Address - Fax:207-594-5499
Practice Address - Street 1:166 NEW COUNTY ROAD
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-0703
Practice Address - Country:US
Practice Address - Phone:207-594-8433
Practice Address - Fax:207-594-5499
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC1397101YA0400X
MECCS4523101YA0400X
MECC1372101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME322910099Medicaid