=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023305950
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAREN FORBERG, LCSW, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2011
-----------------------------------------------------
Last Update Date | 06/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5801 PELICAN BAY BLVD STE 601
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34108-2755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-434-2929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5801 PELICAN BAY BLVD STE 601
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34108-2755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-434-2929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT / OPERATOR
-----------------------------------------------------
Name | KAREN FORBERG
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 239-285-2929
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW6438
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------