Basic Information
| Provider Information | |||||||||
| NPI: | 1407948615 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOODRING | ||||||||
| FirstName: | KIRK | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.S.W.,LICSW,CGP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 SANDGULLY RD | ||||||||
| Address2: | |||||||||
| City: | SOUTH DEERFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013737304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137737089 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 342 BIRNIE AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137470705 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1029173 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.