Provider Demographics
NPI:1669734125
Name:LA FORGIA, ELISABETH (LSW)
Entity type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:
Last Name:LA FORGIA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:
Other - Last Name:BERNSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1848
Mailing Address - Country:US
Mailing Address - Phone:201-934-1160
Mailing Address - Fax:
Practice Address - Street 1:1 CHERRY LN
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1848
Practice Address - Country:US
Practice Address - Phone:201-934-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05564400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker