Individual
PHYLLIS WIDBUR CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
15 RAVENNA RD, ROSLINDALE, MA 02131
(617) 325-6759
Mailing address
15 RAVENNA RD, ROSLINDALE, MA 02131
(617) 325-6759
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
100299
MA
163W00000X
Registered Nurse
Primary
RN68987
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16412
UBH
MA
01
—
A025829
PACIFICARE
MA
Enumeration date
12/26/2006
Last updated
09/11/2025
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