Provider Demographics
NPI:1427453877
Name:FORWARD PSYCHOLOGY GROUP
Entity type:Organization
Organization Name:FORWARD PSYCHOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:HERZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:608-833-7533
Mailing Address - Street 1:478 COMMERCE DR STE 204
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-5099
Mailing Address - Country:US
Mailing Address - Phone:608-833-7533
Mailing Address - Fax:
Practice Address - Street 1:478 COMMERCE DR STE 204
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-5099
Practice Address - Country:US
Practice Address - Phone:608-833-7533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI 1715103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty