Healthcare Provider Details

I. General information

NPI: 1669936431
Provider Name (Legal Business Name): JAMES FORGAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JIM FORGAN PHD

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 UNIVERSITY BLVD STE 114
JUPITER FL
33458-2793
US

IV. Provider business mailing address

641 UNIVERSITY BLVD STE 114
JUPITER FL
33458-2793
US

V. Phone/Fax

Practice location:
  • Phone: 561-203-6007
  • Fax:
Mailing address:
  • Phone: 561-203-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS788
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: