Healthcare Provider Details

I. General information

NPI: 1316051311
Provider Name (Legal Business Name): WENDY J FORBUSH MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4364 ACUSHNET AVE
NEW BEDFORD MA
02745-4614
US

IV. Provider business mailing address

142 CARROLL ST
NEW BEDFORD MA
02740-2320
US

V. Phone/Fax

Practice location:
  • Phone: 508-998-2700
  • Fax: 508-998-2176
Mailing address:
  • Phone: 508-994-8214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW 107025
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: