Healthcare Provider Details

I. General information

NPI: 1750278487
Provider Name (Legal Business Name): FORGE YOURSELF COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 SAVOY ST
WORCESTER MA
01607-1708
US

IV. Provider business mailing address

33 SAVOY ST
WORCESTER MA
01607-1708
US

V. Phone/Fax

Practice location:
  • Phone: 786-506-5287
  • Fax:
Mailing address:
  • Phone: 786-506-5287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: GERMAIN F PEAGUI
Title or Position: OWNER
Credential: LMHC
Phone: 786-506-5287