Provider Demographics
NPI:1902130107
Name:MAURA WOODWARD, LLC
Entity Type:Organization
Organization Name:MAURA WOODWARD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-287-0601
Mailing Address - Street 1:2560 DIXWELL AVE
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1851
Mailing Address - Country:US
Mailing Address - Phone:203-287-0601
Mailing Address - Fax:
Practice Address - Street 1:2560 DIXWELL AVE
Practice Address - Street 2:SUITE 3C
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-1851
Practice Address - Country:US
Practice Address - Phone:203-287-0601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001935363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty