Healthcare Provider Details

I. General information

NPI: 1275938607
Provider Name (Legal Business Name): MARCUS READ FORBES PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 ROCHESTER CT
MIDLOTHIAN VA
23113-6471
US

IV. Provider business mailing address

2300 ROCHESTER CT
MIDLOTHIAN VA
23113-6471
US

V. Phone/Fax

Practice location:
  • Phone: 804-269-7484
  • Fax:
Mailing address:
  • Phone: 804-504-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810001856
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number0812000642
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: