Provider Demographics
NPI:1831468529
Name:WOOLDRIDGE, KIMBERLY A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:WOOLDRIDGE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 CHASE RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068
Mailing Address - Country:US
Mailing Address - Phone:904-505-7624
Mailing Address - Fax:
Practice Address - Street 1:2100 NAPA VALLEJO HWY
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6234
Practice Address - Country:US
Practice Address - Phone:707-253-5017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-24
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042485A103TC0700X
CAPSY 25233103TC0700X
FLPY8974103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400068662Medicare PIN