Provider Demographics
NPI:1679239198
Name:WOODY, MARY LOUISE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:LOUISE
Last Name:WOODY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LIBERTY AVE APT 215
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-1271
Mailing Address - Country:US
Mailing Address - Phone:412-906-9373
Mailing Address - Fax:
Practice Address - Street 1:4415 5TH AVE STE 160
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2654
Practice Address - Country:US
Practice Address - Phone:412-246-5811
Practice Address - Fax:412-246-5815
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019150103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist