Provider Demographics
NPI:1871035931
Name:WOODS, JAMIE KATHRYN (LISW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:KATHRYN
Last Name:WOODS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:KATHRYN
Other - Last Name:BEALS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:29525 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4644
Mailing Address - Country:US
Mailing Address - Phone:216-342-4735
Mailing Address - Fax:216-342-4997
Practice Address - Street 1:29525 CHAGRIN BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4644
Practice Address - Country:US
Practice Address - Phone:216-342-4735
Practice Address - Fax:216-342-4997
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI12007181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical