Provider Demographics
NPI:1922163674
Name:FORLEO, RICHARD PAUL (LICSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PAUL
Last Name:FORLEO
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DAVIDSON AVE
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-3841
Mailing Address - Country:US
Mailing Address - Phone:603-424-8583
Mailing Address - Fax:
Practice Address - Street 1:579 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-3407
Practice Address - Country:US
Practice Address - Phone:603-429-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7541041C0700X
MA1056971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MH30420303Medicaid