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General NPI Number Information
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NPI Number | 1689021818
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Entity Type | Organization
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Legal Business Name | MARY ANN FORSTER, LCSW, LLC
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Dates
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Enumeration Date | 05/17/2016
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Last Update Date | 05/17/2016
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Provider Practice Location Address
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Address Line | 101 PARK ST SUITE 1
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2963
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Country | US
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Telephone | 201-503-4943
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Fax |
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Provider Business Mailing Address
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Address Line | 111 ARNOT PL
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City | WOOD RIDGE
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State | NJ
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Zip | 07075-1426
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Country | US
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Telephone | 201-503-4943
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARY ANN FORSTER
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Credential | LCSW
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Telephone | 201-503-4943
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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 | SC043365
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License Number State | NJ
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