MEDICARE: ANN MARIE BECKLEY-FOREST LCSW

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
1	1041C0700X	Clinical Social Worker	73 072043	NY

General Provider Information

NPI Number	:	1942465042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MARIE BECKLEY-FOREST LCSW

Provider Business Mailing Address
First Line	:	19 ELAM PL
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14214-1910
Country	:	US
Telephone Number	:	716-553-2256
Fax Number	:

Provider Business Practice Location Address
First Line	:	1837 HERTEL AVE
Second Line	:	STE 2
City	:	BUFFALO
State	:	NY
Zip	:	14216-3006
Country	:	US
Telephone Number	:	716-553-2256
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2008
Last Update Date	:	01/23/2018

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