Provider Demographics
NPI:1912087776
Name:WOODARD, LESHELLE D (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESHELLE
Middle Name:D
Last Name:WOODARD
Suffix:
Gender:F
Credentials:PHD
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 934
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339
Mailing Address - Country:US
Mailing Address - Phone:617-552-5124
Mailing Address - Fax:888-317-2641
Practice Address - Street 1:427 COLUMBIA RD 108
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-3213
Practice Address - Country:US
Practice Address - Phone:617-552-5124
Practice Address - Fax:888-317-2641
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MA8649103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0584703Medicaid
MAW5159801Medicare PIN