Provider Demographics
NPI:1306986401
Name:WOOLDRIDGE, MARY JANE (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:WOOLDRIDGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 TURKEY RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:22713-1802
Mailing Address - Country:US
Mailing Address - Phone:540-829-2393
Mailing Address - Fax:
Practice Address - Street 1:700 SOUTHRIDGE PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3723
Practice Address - Country:US
Practice Address - Phone:540-829-2393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003463101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008911339Medicaid
TX7976095Medicare UPIN
VA207391Medicare UPIN
VA008911339Medicaid
VA800002514Medicare ID - Type Unspecified
MD293239Medicare UPIN
NYA758459Medicare UPIN