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General NPI Number Information
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NPI Number | 1154094035
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Entity Type | Organization
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Legal Business Name | FORWARD THERAPEUTIC CENTER
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Dates
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Enumeration Date | 07/27/2021
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 4850 CONNECTICUT AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20008-5941
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Country | US
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Telephone | 332-223-9613
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Fax |
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Provider Business Mailing Address
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Address Line | 1672 PARK AVE APT 3D
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City | NEW YORK
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State | NY
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Zip | 10035-4653
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Country | US
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Telephone | 332-223-9613
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | HAYWARD MOUTON
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Credential |
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Telephone | 332-223-9613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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