Provider Demographics
NPI:1427061613
Name:FORRESTALL, JAMES R (LICSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:FORRESTALL
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 ROUTE 101
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110
Mailing Address - Country:US
Mailing Address - Phone:603-668-0255
Mailing Address - Fax:603-668-0250
Practice Address - Street 1:288 ROUTE 101
Practice Address - Street 2:SUITE 101
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110
Practice Address - Country:US
Practice Address - Phone:603-668-0255
Practice Address - Fax:603-668-0250
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH895104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker