Provider Demographics
NPI:1184108292
Name:WOODFORK, NANCY ANN (MSW,LICSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANN
Last Name:WOODFORK
Suffix:
Gender:F
Credentials:MSW,LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 MYSTIC VALLEY PKWY APT W315
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5741
Mailing Address - Country:US
Mailing Address - Phone:617-306-1613
Mailing Address - Fax:
Practice Address - Street 1:3600 MYSTIC VALLEY PKWY APT W315
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5741
Practice Address - Country:US
Practice Address - Phone:617-306-1613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1038381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical