Active NPI
Susan L. Forkus, LCPC
- Professional Counselor
- Bryant Pond, ME
National Provider Identifier
1124350749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- CC1048
- Practice address
- 201 S Main St
Bryant Pond, ME 04219-6431 - Phone
- (207) 665-2616
- NPI assigned
- Feb 6, 2010
- Last updated
- Feb 6, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | CC1048 | ME | Primary |
Addresses
Primary practice location
201 S Main St
Bryant Pond, ME 04219-6431
Mailing address
PO Box 15
201 South Main Street
Bryant Pond, ME 04219-0015
Phone (207) 665-2616
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CC1048 | ME | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265414400000",
"number": "1124350749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 15",
"address_2": "201 SOUTH MAIN STREET",
"city": "BRYANT POND",
"state": "ME",
"postal_code": "042190015",
"telephone_number": "207-665-2616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 S MAIN ST",
"city": "BRYANT POND",
"state": "ME",
"postal_code": "042196431",
"telephone_number": "207-665-2616"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORKUS",
"first_name": "SUSAN",
"middle_name": "L.",
"name_prefix": "Ms.",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-02-06",
"last_updated": "2010-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ME",
"license": "CC1048",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bryant Pond, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.