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NPI Code Detail

MEDICARE: MRS. RANDI LYNN FORBES LMSW, CASAC

MEDICARE: MRS. RANDI LYNN FORBES LMSW, CASAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker111208-01NY

General Provider Information

NPI Number : 1356937288
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. RANDI LYNN FORBES LMSW, CASAC
Provider Business Mailing Address
First Line : 595 W MAIN ST
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-1381
Country : US
Telephone Number : 315-788-1530
Fax Number :
Provider Business Practice Location Address
First Line : 595 W MAIN ST
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-1381
Country : US
Telephone Number : 315-788-1530
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2020
Last Update Date : 12/18/2020

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