Provider Demographics
NPI:1972629327
Name:FORSEY, PAMELA H (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:H
Last Name:FORSEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52305 OAK RUN DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-7411
Mailing Address - Country:US
Mailing Address - Phone:574-233-4183
Mailing Address - Fax:574-273-1229
Practice Address - Street 1:2319 EDISON RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-3515
Practice Address - Country:US
Practice Address - Phone:574-233-4183
Practice Address - Fax:574-273-1229
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IN34003949A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000212216OtherANTHEM