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General NPI Number Information
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NPI Number | 1750926028
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Entity Type | Organization
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Legal Business Name | FORWARD PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 11/11/2019
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Last Update Date | 11/11/2019
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Provider Practice Location Address
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Address Line | 100 S BROAD ST STE 920
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City | PHILADELPHIA
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State | PA
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Zip | 19110-1016
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Country | US
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Telephone | 610-716-8290
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Fax |
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Provider Business Mailing Address
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Address Line | 226 W RITTENHOUSE SQ APT 2113
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City | PHILADELPHIA
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State | PA
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Zip | 19103-5752
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Country | US
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Telephone | 610-716-8290
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Fax |
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Authorized Official
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Title or Position | PRACTICE DIRECTOR/THERAPIST
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Name | LESLEY PAIG SAGALOW
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Credential | M.ED., LPC, NCC
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Telephone | 610-716-8290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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