Provider Demographics
NPI:1669906491
Name:FORBES, JOAN ELISE (LCSW)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:ELISE
Last Name:FORBES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:J.
Other - Middle Name:ELISE
Other - Last Name:FORBES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:11 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-3654
Mailing Address - Country:US
Mailing Address - Phone:860-717-2007
Mailing Address - Fax:
Practice Address - Street 1:11 MAIN ST
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-3654
Practice Address - Country:US
Practice Address - Phone:860-303-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0097571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical