Provider Demographics
NPI:1588701965
Name:WOOD, THERESA C (LCSW)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:C
Last Name:WOOD
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 1:3 SUMMERS PLACE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5999
Mailing Address - Country:US
Mailing Address - Phone:516-546-4328
Mailing Address - Fax:516-485-2602
Practice Address - Street 1:3 SUMMERS PL
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-2599
Practice Address - Country:US
Practice Address - Phone:516-546-4328
Practice Address - Fax:516-485-2602
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0745621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical