Provider Demographics
NPI:1649161670
Name:WIEGANDT, CARMEN (MSW)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:WIEGANDT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 NOBSKA WAY
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-2563
Mailing Address - Country:US
Mailing Address - Phone:508-209-3263
Mailing Address - Fax:
Practice Address - Street 1:225 W 35TH ST FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1975
Practice Address - Country:US
Practice Address - Phone:917-909-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1278511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical