Provider Demographics
NPI:1881007342
Name:WOOD, RONALD (PSYD, MDIV, LMHC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:PSYD, MDIV, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 CARRIAGE HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-7251
Mailing Address - Country:US
Mailing Address - Phone:813-695-7894
Mailing Address - Fax:727-245-8796
Practice Address - Street 1:473 CARRIAGE HOUSE LN
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688-7251
Practice Address - Country:US
Practice Address - Phone:813-695-7894
Practice Address - Fax:727-245-8796
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16840101YM0800X
FLIMH 11844101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105585700Medicaid