Provider Demographics
NPI:1093470015
Name:FORCHE, BROOKE C (LSW,MSW)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:C
Last Name:FORCHE
Suffix:
Gender:F
Credentials:LSW,MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5526 DORR ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-3612
Mailing Address - Country:US
Mailing Address - Phone:419-262-0189
Mailing Address - Fax:
Practice Address - Street 1:6545 W CENTRAL AVE STE 203
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1034
Practice Address - Country:US
Practice Address - Phone:567-343-3377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2405369104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker