Provider Demographics
NPI:1548530561
Name:WOTT, CARISSA (PHD)
Entity type:Individual
Prefix:DR
First Name:CARISSA
Middle Name:
Last Name:WOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:COIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:830 W SOUTH BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5238
Mailing Address - Country:US
Mailing Address - Phone:419-931-3020
Mailing Address - Fax:419-931-3022
Practice Address - Street 1:830 W SOUTH BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551
Practice Address - Country:US
Practice Address - Phone:419-931-3020
Practice Address - Fax:419-931-3022
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6875103TH0004X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth