Provider Demographics
NPI:1942813795
Name:WOODRUFF, TARA (CAP)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4663 SE BINNACLE WAY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-1930
Mailing Address - Country:US
Mailing Address - Phone:772-409-3828
Mailing Address - Fax:
Practice Address - Street 1:1100 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-1973
Practice Address - Country:US
Practice Address - Phone:561-889-4815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-30
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker