Provider Demographics
NPI:1902382633
Name:WOODFORK, MATTHEW (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:WOODFORK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 SW 147TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-6105
Mailing Address - Country:US
Mailing Address - Phone:786-505-2452
Mailing Address - Fax:
Practice Address - Street 1:9240 SUNSET DR STE 206
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3263
Practice Address - Country:US
Practice Address - Phone:315-380-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8931103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist