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General NPI Number Information
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NPI Number | 1174145601
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Entity Type | Organization
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Legal Business Name | ROBERT J. FORESTI, LCSW, PLLC
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 05/10/2020
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Provider Practice Location Address
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Address Line | 4914 W GENESEE ST
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City | CAMILLUS
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State | NY
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Zip | 13031-2374
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Country | US
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Telephone | 315-636-0120
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Fax |
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Provider Business Mailing Address
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Address Line | 4914 W GENESEE ST
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City | CAMILLUS
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State | NY
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Zip | 13031-2374
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | ROBERT FORESTI
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Credential | LCSW-R
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Telephone | 315-636-0120
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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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