Provider Demographics
NPI:1871693390
Name:WOODWARD, BRUCE (PHD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:WOODWARD
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 7175
Mailing Address - Street 2:
Mailing Address - City:SAINT DAVIDS
Mailing Address - State:PA
Mailing Address - Zip Code:19087-7175
Mailing Address - Country:US
Mailing Address - Phone:610-688-1650
Mailing Address - Fax:
Practice Address - Street 1:175 STRAFFORD AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087
Practice Address - Country:US
Practice Address - Phone:610-688-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003235L103TC1900X, 103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA273480000OtherKEYSTONE
PA2321316000OtherIBC
PA7443321OtherAETNA