Provider Demographics
NPI:1013078658
Name:FORSTER, MARY ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:FORSTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARY ANN
Other - Middle Name:
Other - Last Name:FORSTER-KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:111 ARNOT PL
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-1426
Mailing Address - Country:US
Mailing Address - Phone:201-503-4943
Mailing Address - Fax:
Practice Address - Street 1:101 PARK ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2963
Practice Address - Country:US
Practice Address - Phone:201-503-4943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC04336500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ740541Medicare PIN