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General NPI Number Information
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NPI Number | 1306855630
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Entity Type | Individual
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Provider Name | GINA MARIE FORGETTE LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 2975 MCMILLAN AVE
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-6768
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Country | US
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Telephone | 805-781-4213
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Fax | 805-781-1265
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Provider Business Mailing Address
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Address Line | 2178 JOHNSON AVE
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-4535
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Country | US
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Telephone | 805-781-4213
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Fax | 805-781-1265
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 26403
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License Number State | CA
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