Provider Demographics
NPI:1427087964
Name:WOOD, RANDY PAT (PHD)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:PAT
Last Name:WOOD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 E MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2646
Mailing Address - Country:US
Mailing Address - Phone:805-653-6899
Mailing Address - Fax:805-653-6899
Practice Address - Street 1:2580 E MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2646
Practice Address - Country:US
Practice Address - Phone:805-653-6899
Practice Address - Fax:805-653-6899
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7570103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP7570Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST
CACP7570Medicare PIN