Healthcare Provider Details

I. General information

NPI: 1790058766
Provider Name (Legal Business Name): BARRY LEE FORREST LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 SUMMIT AVE
KENSINGTON MD
20895-2422
US

IV. Provider business mailing address

10500 SUMMIT AVE
KENSINGTON MD
20895-2422
US

V. Phone/Fax

Practice location:
  • Phone: 301-897-2500
  • Fax:
Mailing address:
  • Phone: 301-897-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13240
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: