Provider Demographics
NPI:1962837997
Name:WISHNOV, CAROL ANN (MSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:WISHNOV
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 1:22722 MERIDIANA DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-6313
Mailing Address - Country:US
Mailing Address - Phone:561-289-2550
Mailing Address - Fax:
Practice Address - Street 1:22722 MERIDIANA DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-6313
Practice Address - Country:US
Practice Address - Phone:561-289-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW131771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical