Carlson, Phyllis Widbur

Carlson, Phyllis Widbur is an individual health care provider with primary practice located at 15 Ravenna Rd , Roslindale MA 02131. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Social Worker, Nursing Service Providers / Registered Nurse. Behavioral Health & Social Service Providers / Social Worker is her primary health care specialty. Carlson, Phyllis Widbur can be contacted via phone (617) 325-6759.

Contact Information

Primary practice address
15 Ravenna Rd Roslindale MA 02131
Phone: (617) 325-6759
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Social Worker 104100000X 100299 Massachusetts
Nursing Service Providers / Registered Nurse 163W00000X RN68987 Massachusetts

Profile Details

NPI number 1154486603
LBN Legal business name Carlson, Phyllis Widbur
Credentials LICSW
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 26th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154486603 NPPES
Massachusetts Other A025829 PACIFICARE
Massachusetts Other 16412 PACIFICARE

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