Forman, Susan
Forman, Susan is an individual health care provider with primary practice located at 270 Amity Rd Suite 130, Woodbridge CT 06525. She recently has only one registered license in Behavioral Health & Social Service Providers / Social Worker, which is considered as her primary health care specialty. Forman, Susan can be contacted via phone (203) 397-0064.Contact Information
Primary practice address
270 Amity Rd Suite 130
Woodbridge CT 06525
Phone: (203) 397-0064
Fax: (203) 397-3537
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Social Worker | 104100000X | 001232 | Connecticut |
Profile Details
| NPI number | 1912010877 |
|---|---|
| LBN Legal business name | Forman, Susan |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 16th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1912010877 | NPPES |
| Other | 11585299 | CAQ0H |
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