Provider Demographics
NPI:1043317480
Name:WOOD-ANTONUCCIO, YVONNE ROBERTA (PHD)
Entity type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:ROBERTA
Last Name:WOOD-ANTONUCCIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:YVONNE
Other - Middle Name:
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4730 ABERFELDY RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-0943
Mailing Address - Country:US
Mailing Address - Phone:775-329-3393
Mailing Address - Fax:775-827-6233
Practice Address - Street 1:3732 LAKESIDE DR
Practice Address - Street 2:STE. 200
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5238
Practice Address - Country:US
Practice Address - Phone:775-329-3393
Practice Address - Fax:775-827-4799
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY116103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV880206538Medicare ID - Type Unspecified