Provider Demographics
NPI:1972208742
Name:WOODMAN, AMY L (MSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:WOODMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DELAWARE PL
Mailing Address - Street 2:
Mailing Address - City:MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04462-1922
Mailing Address - Country:US
Mailing Address - Phone:207-794-4417
Mailing Address - Fax:
Practice Address - Street 1:9 FIELD ST STE 219
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6643
Practice Address - Country:US
Practice Address - Phone:207-505-6082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELS14359104100000X, 171M00000X
MEMC224421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator