Provider Demographics
NPI:1669081196
Name:WOOFENDEN, NORA (MA, MT-BC)
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:
Last Name:WOOFENDEN
Suffix:
Gender:F
Credentials:MA, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SHANNON ST # 2
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3408
Mailing Address - Country:US
Mailing Address - Phone:215-264-9263
Mailing Address - Fax:
Practice Address - Street 1:19 SHANNON ST # 2
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3408
Practice Address - Country:US
Practice Address - Phone:215-264-9263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health