Provider Demographics
NPI:1144239971
Name:FORBERG, LCSW, P.A., KAREN (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:FORBERG, LCSW, P.A.
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:FORBERG
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:5801 PELICAN BAY BLVD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-2755
Mailing Address - Country:US
Mailing Address - Phone:239-434-2929
Mailing Address - Fax:
Practice Address - Street 1:5801 PELICAN BAY BLVD
Practice Address - Street 2:SUITE 601
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2755
Practice Address - Country:US
Practice Address - Phone:239-434-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL64381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9523Medicare ID - Type UnspecifiedLCSW