Provider Demographics
NPI:1447497227
Name:FORREST, ELIZABETH ZEA (LICSW, LCSW-C)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ZEA
Last Name:FORREST
Suffix:
Gender:F
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9 HANOVER STREET, SUITE 2
Mailing Address - Street 2:WEST CENTRAL SERVICES
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766
Mailing Address - Country:US
Mailing Address - Phone:603-448-0126
Mailing Address - Fax:603-448-6001
Practice Address - Street 1:140 NORTH STREET
Practice Address - Street 2:WEST CENTRAL SERVICES
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743
Practice Address - Country:US
Practice Address - Phone:603-542-2578
Practice Address - Fax:603-542-5456
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00012231041C0700X
MD074911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical