Healthcare Provider Details

I. General information

NPI: 1962572750
Provider Name (Legal Business Name): DAVID B WOHLSIFER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 CAMINO GARDENS BLVD SUITE 117
BOCA RATON FL
33432-5816
US

IV. Provider business mailing address

370 CAMINO GARDENS BLVD SUITE 117
BOCA RATON FL
33432-5816
US

V. Phone/Fax

Practice location:
  • Phone: 561-409-9701
  • Fax: 561-922-0371
Mailing address:
  • Phone: 561-409-9701
  • Fax: 561-922-0371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW013309
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 11673
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: