Provider Demographics
NPI:1972669059
Name:FORBECK, CAROL A (MSW-LISW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:FORBECK
Suffix:
Gender:F
Credentials:MSW-LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 BRIGGS PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1905
Mailing Address - Country:US
Mailing Address - Phone:513-631-7955
Mailing Address - Fax:
Practice Address - Street 1:10700 MONTGOMERY RD
Practice Address - Street 2:SUITE 206
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-3255
Practice Address - Country:US
Practice Address - Phone:513-489-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00028771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01274Medicaid