Provider Demographics
NPI:1740477272
Name:WOOD, JUDITH D (LISW)
Entity type:Individual
Prefix:MR
First Name:JUDITH
Middle Name:D
Last Name:WOOD
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11811 SHAKER BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1931
Mailing Address - Country:US
Mailing Address - Phone:216-229-2420
Mailing Address - Fax:216-229-2474
Practice Address - Street 1:11811 SHAKER BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1931
Practice Address - Country:US
Practice Address - Phone:216-229-2420
Practice Address - Fax:216-229-2474
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1.00050251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical