Provider Demographics
NPI:1043096449
Name:FORBES, PAULETTE (LCADC)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:
Last Name:FORBES
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-0510
Mailing Address - Country:US
Mailing Address - Phone:973-623-0600
Mailing Address - Fax:
Practice Address - Street 1:595 COUNTY AVE BLDG 6
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2605
Practice Address - Country:US
Practice Address - Phone:973-623-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00173300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)