Healthcare Provider Details

I. General information

NPI: 1053539478
Provider Name (Legal Business Name): JENNIFER LEIGH FOREST MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER FOREST O'CONNOR MSW

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 RUSSELL RD
PAOLI PA
19301-1236
US

IV. Provider business mailing address

1440 RUSSELL RD
PAOLI PA
19301-1236
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-6464
  • Fax: 610-644-4066
Mailing address:
  • Phone: 610-644-6464
  • Fax: 610-644-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW011301L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: