Provider Demographics
NPI:1023766235
Name:FORMAN-GREENWALD, ANNA (LSW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:FORMAN-GREENWALD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:GREENWALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:1338 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-1528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1338 MOORE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-1528
Practice Address - Country:US
Practice Address - Phone:917-657-2378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1267641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical