Provider Demographics
NPI:1376687699
Name:FORBES, MARGO DWIGHT (MFT)
Entity Type:Individual
Prefix:MS
First Name:MARGO
Middle Name:DWIGHT
Last Name:FORBES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 CREST RD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-2729
Mailing Address - Country:US
Mailing Address - Phone:415-898-6725
Mailing Address - Fax:415-898-1885
Practice Address - Street 1:200 PROFESSIONAL CENTER DR
Practice Address - Street 2:STE 200
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4369
Practice Address - Country:US
Practice Address - Phone:415-898-6725
Practice Address - Fax:415-898-1885
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30352106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist