Provider Demographics
NPI:1134400567
Name:FORSEY, SHAJUAN M
Entity type:Individual
Prefix:MISS
First Name:SHAJUAN
Middle Name:M
Last Name:FORSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 MOHAWK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-7665
Mailing Address - Country:US
Mailing Address - Phone:410-744-5200
Mailing Address - Fax:
Practice Address - Street 1:3602 MOHAWK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-7665
Practice Address - Country:US
Practice Address - Phone:410-744-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0002369683101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty