Provider Demographics
NPI:1538531132
Name:WOODARD, DONNA B
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:B
Last Name:WOODARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HART ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1701
Mailing Address - Country:US
Mailing Address - Phone:860-229-4850
Mailing Address - Fax:
Practice Address - Street 1:5 HART ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1701
Practice Address - Country:US
Practice Address - Phone:860-229-4850
Practice Address - Fax:860-827-3472
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5105101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060934544Medicaid