Provider Demographics
NPI:1215328596
Name:FORGWE, MARTIN
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:FORGWE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 390333
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-0004
Mailing Address - Country:US
Mailing Address - Phone:857-540-1404
Mailing Address - Fax:
Practice Address - Street 1:1534 TREMONT ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02120-2929
Practice Address - Country:US
Practice Address - Phone:617-541-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherNHP - NEIGHBORHOOD HEALTH PLAN