Provider Demographics
NPI:1609512599
Name:WISTH, CLAIRE A
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:A
Last Name:WISTH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N 12TH ST # 1-0506
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3100
Mailing Address - Country:US
Mailing Address - Phone:407-951-4138
Mailing Address - Fax:
Practice Address - Street 1:601 N 12TH ST # 1-0506
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-3100
Practice Address - Country:US
Practice Address - Phone:407-951-4138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLRBT-22-205219106S00000X
FL0-25-15864106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician