Provider Demographics
NPI:1851803357
Name:FORTE, TABITHA O (MHC-LP, CASAC-T)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:O
Last Name:FORTE
Suffix:
Gender:F
Credentials:MHC-LP, CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 BROADWAY FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3363
Mailing Address - Country:US
Mailing Address - Phone:212-966-9537
Mailing Address - Fax:
Practice Address - Street 1:598 BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3363
Practice Address - Country:US
Practice Address - Phone:212-966-9537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)