Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 8939 | MA |
NPI | 1063595387 |
---|---|
Provider Name | Sue Woodward |
First Address | Brookline, MA 02445-4445 |
Second Address | Brookline, MA 02445-4445 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 23/12/2011 |