Healthcare Provider Details

I. General information

NPI: 1780274969
Provider Name (Legal Business Name): BRIAN PATRICK FORAN MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/21/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 E NEWTON ST
BOSTON MA
02118-3553
US

IV. Provider business mailing address

11 FENWICK ST APT 2
SOMERVILLE MA
02145-2408
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-8336
  • Fax:
Mailing address:
  • Phone: 781-859-8643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: