MEDICARE: JOANNA FORESTER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C004799	NC

General Provider Information

NPI Number	:	1154599033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA FORESTER LCSW

Provider Business Mailing Address
First Line	:	109 NEWHOUSE CT
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-8305
Country	:	US
Telephone Number	:	919-219-1043
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 NEWHOUSE CT
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-8305
Country	:	US
Telephone Number	:	919-219-1043
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	05/28/2010

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