1316051311 NPI number — MS. WENDY J FORBUSH MSW

Table of content: MS. WENDY J FORBUSH MSW (NPI 1316051311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316051311 NPI number — MS. WENDY J FORBUSH MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORBUSH
Provider First Name:
WENDY
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316051311
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
142 CARROLL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BEDFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02740-2320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-994-8214
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4364 ACUSHNET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BEDFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02745-4614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-998-2700
Provider Business Practice Location Address Fax Number:
508-998-2176
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LICSW 107025 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 772233 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8872-01 . This is a "PACIFICARE (HARVAD PILGRI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6223137 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 008003 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410260 . This is a "BLUE CHIP OF BCBS RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 032119000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1019230 . This is a "BEACON HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3173-2 . This is a "BLUE CROSS BLUE SHIELD RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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