Provider Demographics
NPI:1912323650
Name:FORTE, LAURA JEANINE (LCSW-R)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEANINE
Last Name:FORTE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13880 SHELBY TRL
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-1576
Mailing Address - Country:US
Mailing Address - Phone:917-995-1362
Mailing Address - Fax:
Practice Address - Street 1:13880 SHELBY TRL
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-1576
Practice Address - Country:US
Practice Address - Phone:917-995-1362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072223251E00000X
NYR0722231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY275273404Medicaid