Provider Demographics
NPI:1689750903
Name:FORBES, SUSAN G (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:G
Last Name:FORBES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 WASHINGTON ST STE 10
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-5747
Mailing Address - Country:US
Mailing Address - Phone:781-848-6171
Mailing Address - Fax:781-848-6172
Practice Address - Street 1:654 WASHINGTON ST.
Practice Address - Street 2:SUITE 10
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:781-848-6171
Practice Address - Fax:781-848-6172
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10249291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1853791Medicaid
MA1853791Medicaid