Provider Demographics
NPI:1740761170
Name:WIZANSKY, MARGOT G (MSW)
Entity Type:Individual
Prefix:
First Name:MARGOT
Middle Name:G
Last Name:WIZANSKY
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 1:12 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6841
Mailing Address - Country:US
Mailing Address - Phone:617-921-4719
Mailing Address - Fax:
Practice Address - Street 1:12 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6841
Practice Address - Country:US
Practice Address - Phone:617-921-4719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1019571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical