Provider Demographics
NPI:1043022577
Name:WOODWARD, MATTHEW T (LCSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:T
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 STOCKER AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-1226
Mailing Address - Country:US
Mailing Address - Phone:781-913-9280
Mailing Address - Fax:
Practice Address - Street 1:50 DUNHAM RIDGE ROAD
Practice Address - Street 2:SUITE 3200-3350
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-600-0816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW230836104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker