Active NPI
Forrest Wilson Seymour, LICSW
- Clinical Social Worker
- Keene, NH
National Provider Identifier
1568489128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LICSW 1318
- Practice address
- 103 Roxbury St
Suite 207
Keene, NH 03431-8801 - Phone
- (603) 721-9979
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LICSW 1318 | NH | Primary |
Addresses
Primary practice location
103 Roxbury St
Suite 207
Keene, NH 03431-8801
Mailing address
42 Douglass St
Keene, NH 03431-3227
Phone (603) 721-9979
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070330000235 | NH | Practitioner - Clinical Social Worker | 1254435209 | Practice locations: Keene, NH |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2001
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
Keene, NH 03431
Phone (603) 721-9979
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1318 | NH | MD | Psychologist |
| LICSW 1318 | NH | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1568489128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "42 DOUGLASS ST",
"city": "KEENE",
"state": "NH",
"postal_code": "034313227",
"telephone_number": "603-721-9979",
"fax_number": "603-721-9979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 ROXBURY ST",
"address_2": "SUITE 207",
"city": "KEENE",
"state": "NH",
"postal_code": "034318801",
"telephone_number": "603-721-9979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEYMOUR",
"first_name": "FORREST",
"middle_name": "WILSON",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NH",
"license": "LICSW 1318",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Keene, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.