1861589491 NPI number — MR. RICHARD WOODCOCK LCSW

Table of content: MR. RICHARD WOODCOCK LCSW (NPI 1861589491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861589491 NPI number — MR. RICHARD WOODCOCK LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODCOCK
Provider First Name:
RICHARD
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861589491
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 LINCOLN ST
Provider Second Line Business Mailing Address:
STE 216
Provider Business Mailing Address City Name:
SACO
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04072-3113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-342-8764
Provider Business Mailing Address Fax Number:
888-342-8764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 LINCOLN ST
Provider Second Line Business Practice Location Address:
STE 216
Provider Business Practice Location Address City Name:
SACO
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04072-3113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-342-8764
Provider Business Practice Location Address Fax Number:
888-342-8764
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LC7013 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ME2187 . This is a "MEDICARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 403740099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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