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General NPI Number Information
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NPI Number | 1215328596
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Entity Type | Individual
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Provider Name | MARTIN FORGWE
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Gender | Male
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 1534 TREMONT ST
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City | ROXBURY
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State | MA
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Zip | 02120-2929
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Country | US
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Telephone | 617-541-9900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 390333
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City | CAMBRIDGE
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State | MA
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Zip | 02139-0004
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Country | US
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Telephone | 857-540-1404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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