| Forest Licensed Clinical Social Work P.c. | |
|
2691 State Route 9 # 204 Malta NY 12020-4319 | |
| (518) 400-1448 | |
| Not Available |
| Full Name | Forest Licensed Clinical Social Work P.c. |
|---|---|
| Speciality | Social Worker |
| Location | 2691 State Route 9 # 204, Malta, New York |
| Authorized Official Name and Position | Jenness Clairmont (PROVIDER) |
| Authorized Official Contact | 5184001448 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Forest Licensed Clinical Social Work P.c. 2691 State Route 9 # 204 Malta NY 12020-4319 Ph: (518) 400-1448 | Forest Licensed Clinical Social Work P.c. 2691 State Route 9 # 204 Malta NY 12020-4319 Ph: (518) 400-1448 |
| NPI Number | 1679968861 |
|---|---|
| Provider Enumeration Date | 04/03/2015 |
| Last Update Date | 06/04/2021 |
| Certification Date | 06/04/2021 |
| Medicare PECOS PAC ID | 7012279383 |
|---|---|
| Medicare Enrollment ID | O20180326002157 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679968861 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | R071476-1 (New York) | Primary |
| Provider Name | Jenness E Clairmont |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538272265 PECOS PAC ID: 6305810300 Enrollment ID: I20040825000264 |
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