Active NPI
Phyllis Widbur Carlson, LICSW
- Registered Nurse
- Roslindale, MA
National Provider Identifier
1154486603
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN68987
- Practice address
- 15 Ravenna Rd
Roslindale, MA 02131 - Phone
- (617) 325-6759
- NPI assigned
- Dec 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 100299 | MA | |
| Registered Nurse | 163W00000X | RN68987 | MA | Primary |
Addresses
Primary practice location
15 Ravenna Rd
Roslindale, MA 02131
Mailing address
15 Ravenna Rd
Roslindale, MA 02131
Phone (617) 325-6759
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A025829 | Other | MA | PACIFICARE |
| 16412 | Other | MA | UBH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100299 | MA | MD | Social Worker |
| RN68987 | MA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1154486603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 RAVENNA RD",
"city": "ROSLINDALE",
"state": "MA",
"postal_code": "02131",
"telephone_number": "617-325-6759"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 RAVENNA RD",
"city": "ROSLINDALE",
"state": "MA",
"postal_code": "02131",
"telephone_number": "617-325-6759"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "PHYLLIS",
"middle_name": "WIDBUR",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-26",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "100299",
"primary": false
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MA",
"license": "RN68987",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PACIFICARE",
"identifier": "A025829",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH",
"identifier": "16412",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roslindale, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.