Provider Demographics
NPI:1801910831
Name:WOODRUFF, ROMELYN VALDEZ (MA,RN,CS)
Entity type:Individual
Prefix:
First Name:ROMELYN
Middle Name:VALDEZ
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:MA,RN,CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 DOLLY DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-1578
Mailing Address - Country:US
Mailing Address - Phone:401-682-2882
Mailing Address - Fax:
Practice Address - Street 1:2679 E MAIN RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-2613
Practice Address - Country:US
Practice Address - Phone:401-682-2882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1334101YM0800X
RIRN28127163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult