Individual
AGNES MARY WOODLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
80 NEWBRIDGE WAY, DEDHAM, MA 02026-7028
(847) 346-9858
Mailing address
398 COLUMBUS AVE UNIT 646, BOSTON, MA 02116-6008
(847) 346-9858
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
224245
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
224245
SOCIAL WORK LICENSE
MA
Enumeration date
10/06/2020
Last updated
11/27/2023
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