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NPI Code Detail

MEDICARE: MR. PAUL EDWARD FORBES JR. MSW, LCSW

MEDICARE: MR. PAUL EDWARD FORBES JR. MSW, 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
11041C0700XClinical Social WorkerL0392OR

General Provider Information

NPI Number : 1598818650
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PAUL EDWARD FORBES JR. MSW, LCSW
Provider Business Mailing Address
First Line : 1620 THOMPSON RD
Second Line :
City : COOS BAY
State : OR
Zip : 97420-2150
Country : US
Telephone Number : 541-269-2986
Fax Number : 541-269-7987
Provider Business Practice Location Address
First Line : 1620 THOMPSON RD
Second Line :
City : COOS BAY
State : OR
Zip : 97420-2150
Country : US
Telephone Number : 541-269-2986
Fax Number : 541-269-7987
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2007
Last Update Date : 07/09/2007

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