Provider Demographics
NPI:1962700542
Name:WOODWORTH, DORA A (LMSW)
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:A
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DORA
Other - Middle Name:A
Other - Last Name:CORTEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3564 GLENN HILL HWY
Mailing Address - Street 2:
Mailing Address - City:MANITOU BEACH
Mailing Address - State:MI
Mailing Address - Zip Code:49253-9720
Mailing Address - Country:US
Mailing Address - Phone:517-403-3728
Mailing Address - Fax:
Practice Address - Street 1:142 E MAUMEE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2735
Practice Address - Country:US
Practice Address - Phone:517-403-3728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010707871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical