Provider Demographics
NPI:1558168021
Name:FORBES-SHEPPARD, JOLANDA (LICSW)
Entity type:Individual
Prefix:
First Name:JOLANDA
Middle Name:
Last Name:FORBES-SHEPPARD
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 RESERVOIR AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6032
Mailing Address - Country:US
Mailing Address - Phone:401-259-0340
Mailing Address - Fax:401-213-8538
Practice Address - Street 1:1150 RESERVOIR AVE STE 203
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6032
Practice Address - Country:US
Practice Address - Phone:401-259-0340
Practice Address - Fax:401-213-8538
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5911C101YM0800X
RIISW04406101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health