Provider Demographics
NPI:1013079904
Name:WOOD, AMY (PSY D)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04211-1328
Mailing Address - Country:US
Mailing Address - Phone:207-784-9185
Mailing Address - Fax:207-784-1594
Practice Address - Street 1:57 EXCHANGE ST
Practice Address - Street 2:SUITE 403
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-5000
Practice Address - Country:US
Practice Address - Phone:207-772-7542
Practice Address - Fax:207-775-4454
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS9882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM8840Medicare ID - Type Unspecified