Healthcare Provider Details

I. General information

NPI: 1609856152
Provider Name (Legal Business Name): LAURIE JANE FORBES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16499 NE 19TH AVE
NORTH MIAMI BEACH FL
33162-4105
US

IV. Provider business mailing address

3400 NE 192ND ST APT 1610
AVENTURA FL
33180-2458
US

V. Phone/Fax

Practice location:
  • Phone: 305-576-3266
  • Fax:
Mailing address:
  • Phone: 305-794-6685
  • Fax: 305-705-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW0000732
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT0000339
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: