Provider Demographics
NPI:1730460114
Name:FORBES, SANDRA ETHEL (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ETHEL
Last Name:FORBES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2363 S 102ND ST
Mailing Address - Street 2:SUITE#203
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2143
Mailing Address - Country:US
Mailing Address - Phone:414-545-1950
Mailing Address - Fax:
Practice Address - Street 1:2363 S 102ND ST
Practice Address - Street 2:SUITE#203
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2143
Practice Address - Country:US
Practice Address - Phone:414-545-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3978-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical