Provider Demographics
NPI:1679968861
Name:FOREST LICENSED CLINICAL SOCIAL WORK P.C.
Entity Type:Organization
Organization Name:FOREST LICENSED CLINICAL SOCIAL WORK P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNESS
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAIRMONT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R LMFT
Authorized Official - Phone:518-400-1448
Mailing Address - Street 1:2691 STATE ROUTE 9 # 204
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4319
Mailing Address - Country:US
Mailing Address - Phone:518-400-1448
Mailing Address - Fax:
Practice Address - Street 1:2691 STATE ROUTE 9 # 204
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-4319
Practice Address - Country:US
Practice Address - Phone:518-400-1448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR071476-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty