Provider Demographics
NPI:1992725972
Name:WOOD, JEFF (LCSW)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
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:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-0112
Mailing Address - Country:US
Mailing Address - Phone:407-227-8150
Mailing Address - Fax:
Practice Address - Street 1:304 E ROBINSON ST STE 206B
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1935
Practice Address - Country:US
Practice Address - Phone:407-227-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 56981041C0700X
IL149-0211541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9839Medicare ID - Type Unspecified