MEDICARE: MS. ELEANOR MILDRED FORBES

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	104100000X	Social Worker	LSWA414706	MA
2	101YM0800X	Mental Health Counselor	LMHC12969	MA

General Provider Information

NPI Number	:	1194062687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELEANOR MILDRED FORBES

Provider Business Mailing Address
First Line	:	3464 WASHINGTON ST
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-2665
Country	:	US
Telephone Number	:	617-446-3447
Fax Number	:	617-533-1945

Provider Business Practice Location Address
First Line	:	100 HANCOCK ST FL 9
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02171-1745
Country	:	US
Telephone Number	:	617-446-3447
Fax Number	:

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

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	11/24/2023

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