Provider Demographics
NPI:1336349349
Name:WOOD, BETH N (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:N
Last Name:WOOD
Suffix:
Gender:F
Credentials:LMFT
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 1175
Mailing Address - Street 2:
Mailing Address - City:TRURO
Mailing Address - State:MA
Mailing Address - Zip Code:02666-1175
Mailing Address - Country:US
Mailing Address - Phone:508-487-5199
Mailing Address - Fax:
Practice Address - Street 1:43 RACE POINT RD
Practice Address - Street 2:
Practice Address - City:PROVINCETOWN
Practice Address - State:MA
Practice Address - Zip Code:02657-1529
Practice Address - Country:US
Practice Address - Phone:508-487-5199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1303106H00000X
CT000988106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT410000988CT01OtherANTHEM BLUE CROSS/BLUE SH