Provider Demographics
NPI:1689762536
Name:WOODARD, FREDRICK J (PHD)
Entity type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:J
Last Name:WOODARD
Suffix:
Gender:M
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:PO BOX 874
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-0874
Mailing Address - Country:US
Mailing Address - Phone:603-673-2582
Mailing Address - Fax:
Practice Address - Street 1:15 LINCOLN ST
Practice Address - Street 2:B
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055
Practice Address - Country:US
Practice Address - Phone:603-673-2582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1082103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHW0RE8377OtherGROUP
NH3074043Medicaid
NHW0RE8378Medicare ID - Type UnspecifiedINDIVIDUAL