Provider Demographics
NPI:1508193350
Name:TISOT, CAROLINE TERESA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:TERESA
Last Name:TISOT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 LANGHORNE NEWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1232
Mailing Address - Country:US
Mailing Address - Phone:267-756-3007
Mailing Address - Fax:
Practice Address - Street 1:1421 SE 4TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1940
Practice Address - Country:US
Practice Address - Phone:954-766-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-14
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016658103T00000X
FLPY11425103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist