Provider Demographics
NPI:1528650553
Name:FORWARD PROGRESS PERFORAMNCE LLC
Entity type:Organization
Organization Name:FORWARD PROGRESS PERFORAMNCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:781-883-7066
Mailing Address - Street 1:1533 BLUE HERON DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3702
Mailing Address - Country:US
Mailing Address - Phone:781-883-7066
Mailing Address - Fax:
Practice Address - Street 1:55 HOLLETT ST
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066
Practice Address - Country:US
Practice Address - Phone:781-883-7066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty