Provider Information for 1881332237
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Miss JACQUELLA FORGEY-CARPENTER LCSW
Sex: Female
NPI: 1881332237
Last Updated: 2024-04-29
Certification Date: 2024-04-29
Certification Date: 2024-04-29
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1881332237 | ||||||||||||||||
| Enumeration Date | 2022-05-25 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 16149 SW 62ND TER MIAMI, FL 33193-5582 United States Phone: 203-745-6287 | Fax: | ||||||||||||||||
| Primary Practice Address | 16149 SW 62ND TER MIAMI, FL 33193-5582 United States Phone: 203-745-6287 | Fax: | ||||||||||||||||
| Secondary Practice Address(es) | 855 LAKEWOOD RD | ||||||||||||||||
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