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General NPI Number Information
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NPI Number | 1518183862
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Entity Type | Individual
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Provider Name | BONNY J. FORREST J.D., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 311 4TH AVE SUITE 609
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City | SAN DIEGO
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State | CA
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Zip | 92101-6967
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Country | US
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Telephone | 917-687-0271
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Fax |
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Provider Business Mailing Address
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Address Line | 311 4TH AVE SUITE 609
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City | SAN DIEGO
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State | CA
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Zip | 92101-6967
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Country | US
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Telephone | 917-687-0271
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 353
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 353
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 353
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 353
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License Number State | DC
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Taxonomy #5
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | 353
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License Number State | DC
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Taxonomy #6
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | 353
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License Number State | DC
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