Provider Demographics
NPI:1891844098
Name:WOODARD, TRACY CLARK (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:CLARK
Last Name:WOODARD
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FIRESIDE DR
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-3222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 FIRESIDE DR
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-3222
Practice Address - Country:US
Practice Address - Phone:401-737-0820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00089106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1023290OtherBEACON HEALTH STRATEGIES
RIFM49638Medicaid
RI30197-6OtherBLUE CROSS
RI410039OtherBLUE CHIP
RI6229042OtherUNITED HEALTH