Michael Joseph Woodberry, LMHC, CASAC-G, CPP

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

005270 Issued in NY

Practice address

11103 207TH St
Queens Village, NY 11429-1707

Phone

(347) 256-2591

NPI assigned

Jun 2, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445299200000",
    "number": "1306166251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11103 207TH ST",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114291707",
            "telephone_number": "347-256-2591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11103 207TH ST",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114291707",
            "telephone_number": "347-256-2591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODBERRY",
        "first_name": "MICHAEL",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "LMHC, CASAC-G, CPP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-02",
        "last_updated": "2015-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NY",
            "license": "1054",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "12650",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "005270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Philip Wong, RPH
• Talia Yvonnia Wong, LPN
• Ilene Evaoney Wood, OT
• Iyabo Wood, RN
• Patrina Wood
• Carla Wright
• Pricilla Wright
• Shara Serena Wright, RN
• Shirnet Wright, CNA
• Jie Wu

• Mental Health Counselor in Queens Village, NY
• Providers in Queens Village, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.