Provider Demographics
NPI:1194218818
Name:FORGETT, AMANDA (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:FORGETT
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-8237
Mailing Address - Country:US
Mailing Address - Phone:413-499-7924
Mailing Address - Fax:413-442-6284
Practice Address - Street 1:75 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6157
Practice Address - Country:US
Practice Address - Phone:413-499-7924
Practice Address - Fax:413-442-6284
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARBT-17-2608-67237106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician