Provider Demographics
NPI:1548441587
Name:FORTES, SYLVESTER PEREIRA (MSW)
Entity type:Individual
Prefix:MR
First Name:SYLVESTER
Middle Name:PEREIRA
Last Name:FORTES
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3415
Mailing Address - Country:US
Mailing Address - Phone:508-587-8105
Mailing Address - Fax:
Practice Address - Street 1:20 HOPE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3415
Practice Address - Country:US
Practice Address - Phone:508-587-8105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA703101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)