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General NPI Number Information
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NPI Number | 1497743355
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Entity Type | Individual
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Provider Name | MARK J FOREST PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 110 S STATE ST
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City | NEWTOWN
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State | PA
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Zip | 18940-3508
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Country | US
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Telephone | 215-579-1262
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Fax |
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Provider Business Mailing Address
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Address Line | 105 GREENBROOK CT
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City | NEW HOPE
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State | PA
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Zip | 18938-1074
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Country | US
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Telephone | 215-862-6292
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS005255L
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License Number State | PA
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