Provider Demographics
NPI:1598889156
Name:WISCHMEYER, KAREN A (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:A
Last Name:WISCHMEYER
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 1:80 WASHINGTON SQUARE
Mailing Address - Street 2:F-32
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1741
Mailing Address - Country:US
Mailing Address - Phone:781-871-3834
Mailing Address - Fax:
Practice Address - Street 1:80 WASHINGTON SQUARE
Practice Address - Street 2:F-32
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1741
Practice Address - Country:US
Practice Address - Phone:781-871-3834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10179931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP05164Medicare ID - Type UnspecifiedPROVIDER NUMBER