Provider Demographics
NPI:1457496903
Name:FORWARD, SUSAN M (LMHC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:FORWARD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 DARROW ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-3846
Mailing Address - Country:US
Mailing Address - Phone:603-547-0399
Mailing Address - Fax:
Practice Address - Street 1:64 DARROW ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-3846
Practice Address - Country:US
Practice Address - Phone:603-547-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5704101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health