Provider Demographics
NPI:1265511885
Name:FIZER, CAROL WOLEYKO (LICSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:WOLEYKO
Last Name:FIZER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 OAK ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1426
Mailing Address - Country:US
Mailing Address - Phone:917-448-1439
Mailing Address - Fax:
Practice Address - Street 1:797 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWTONVILLE
Practice Address - State:MA
Practice Address - Zip Code:02460-1633
Practice Address - Country:US
Practice Address - Phone:617-448-1439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10326001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1032600OtherMA SOCIAL WORK LICENSE
MA1032600Other|MA SOCIAL WORK LICENSE