Provider Demographics
NPI:1942353438
Name:WOODCOCK, KIMBERLY JEAN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JEAN
Last Name:WOODCOCK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:J
Other - Last Name:MANIERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:165 MAIN ST UNIT 213
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1584
Mailing Address - Country:US
Mailing Address - Phone:508-320-5165
Mailing Address - Fax:508-519-0051
Practice Address - Street 1:165 MAIN ST UNIT 213
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1584
Practice Address - Country:US
Practice Address - Phone:508-320-5165
Practice Address - Fax:508-519-0051
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4694101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2220002001OtherBCBS SUBSTANCE ABUSE
MAM18684OtherBCBS MENTAL HEALTH
MA1306421Medicaid
MA1308785Medicaid
MAY10400Medicare ID - Type Unspecified