Provider Demographics
NPI:1265657340
Name:FORHMAN, BETH ILENE (CSW DSW)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:ILENE
Last Name:FORHMAN
Suffix:
Gender:F
Credentials:CSW DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-361-6633
Mailing Address - Fax:631-584-2341
Practice Address - Street 1:267 E MAIN ST
Practice Address - Street 2:BUILDING B
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-361-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSWPR0192481104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker