Provider Demographics
NPI:1023375508
Name:WOODWARD, CARRIE SUSA (MS, BCBA)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:SUSA
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 E ROSEBAY ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-3527
Mailing Address - Country:US
Mailing Address - Phone:562-233-4899
Mailing Address - Fax:
Practice Address - Street 1:5430 E ROSEBAY ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-3527
Practice Address - Country:US
Practice Address - Phone:562-233-4899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-10-7276103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst